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General NPI Number Information
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NPI Number | 1841292083
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Entity Type | Organization
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Legal Business Name | CENTRAL BAPTIST HOME FOR THE AGED
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 4747 N CANFIELD AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-4480
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Country | US
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Telephone | 708-583-8555
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Fax | 708-583-8455
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Provider Business Mailing Address
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Address Line | 4747 N CANFIELD AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-4480
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Country | US
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Telephone | 708-583-8555
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Fax | 708-583-8455
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHARLES NEWTON
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Credential |
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Telephone | 708-583-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5100364
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0007435
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License Number State | IL
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