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NPI Code Detail

MEDICARE: LAUREATE CHICAGO OPERATIONS LLC

MEDICARE: LAUREATE CHICAGO OPERATIONS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1205488947
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAUREATE CHICAGO OPERATIONS LLC
Provider Business Mailing Address
First Line : 13024 BALLANTYNE CORPORATE PL STE 425
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-4420
Country : US
Telephone Number : 704-426-8849
Fax Number :
Provider Business Practice Location Address
First Line : 4314 S WABASH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3119
Country : US
Telephone Number : 773-538-8300
Fax Number : 773-538-5775
Authorized Official
Title or Position : MANAGER
Name : MR. SHAUN AHMAD
Credential :
Telephone Number : 704-426-8849
Provider Enumeration Date : 07/12/2019
Last Update Date : 07/12/2019

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Directions to “LAUREATE CHICAGO OPERATIONS LLC ” Practice Location

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