MEDICARE: CENTER FOR SENIORS

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	261QA0600X	Adult Day Care Clinic/Center	ADS 1013007	IL
2	261QA0600X	Adult Day Care Clinic/Center	ADS1313002	IL
3	261QA0600X	Adult Day Care Clinic/Center	ADS 1012011	IL

General Provider Information

NPI Number	:	1407105208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SENIORS

Provider Business Mailing Address
First Line	:	5320 N. KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4712
Country	:	US
Telephone Number	:	773-478-1245
Fax Number	:	773-478-4070

Provider Business Practice Location Address
First Line	:	5320 N. KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4712
Country	:	US
Telephone Number	:	773-478-1245
Fax Number	:	773-478-4070

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAE KWAN HA
Credential	:
Telephone Number	:	773-478-1245

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	04/25/2013

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Directions to “CENTER FOR SENIORS ” Practice Location

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