MEDICARE: THE CHILDREN'S PLACE ASSOCIATION

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
1	3140N1450X	Pediatric Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	335263-02	OTHER	IL	DCFS LISCENSE

General Provider Information

NPI Number	:	1275560237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN'S PLACE ASSOCIATION

Provider Business Mailing Address
First Line	:	3059 W. AUGUSTA BLVD.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60010
Country	:	US
Telephone Number	:	773-826-1230
Fax Number	:	773-826-0705

Provider Business Practice Location Address
First Line	:	3059 W AUGUSTA BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4314
Country	:	US
Telephone Number	:	773-826-1230
Fax Number	:	773-826-0705

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MS. CATHY KRIEGER
Credential	:
Telephone Number	:	773-826-1230

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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Directions to “THE CHILDREN'S PLACE ASSOCIATION ” Practice Location

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