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General NPI Number Information
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NPI Number | 1891367330
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Entity Type | Organization
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Legal Business Name | ILLINOIS VETERANS HOME AT CHICAGO
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 4250 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1417
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Country | US
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Telephone | 773-794-3763
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | T'KIRA SILER-WILKERSON
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Credential |
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Telephone | 773-628-5905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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