MEDICARE: CHICAGOLAND METHODIST SENIOR SERVICES

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	314000000X	Skilled Nursing Facility	1748898	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1151	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1316057318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGOLAND METHODIST SENIOR SERVICES

Provider Business Mailing Address
First Line	:	1415 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2288
Country	:	US
Telephone Number	:	773-769-5500
Fax Number	:	773-769-6287

Provider Business Practice Location Address
First Line	:	1415 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2288
Country	:	US
Telephone Number	:	773-769-5500
Fax Number	:	773-769-6287

Authorized Official
Title or Position	:	CONTROLLER
Name	:	FROILAN NUNEZ
Credential	:
Telephone Number	:	773-596-2230

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/17/2024

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