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NPI Code Detail

MEDICARE: BEACON CARE CENTER LLC

MEDICARE: BEACON CARE CENTER 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 FacilityIL

General Provider Information

NPI Number : 1417496142
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON CARE CENTER LLC
Provider Business Mailing Address
First Line : 4538 N BEACON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5519
Country : US
Telephone Number : 773-275-7200
Fax Number : 773-275-7548
Provider Business Practice Location Address
First Line : 4538 N BEACON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5519
Country : US
Telephone Number : 773-275-7200
Fax Number : 773-275-7548
Authorized Official
Title or Position : ATTORNEY
Name : MS. FRANCES MEEHAN
Credential : ESQ
Telephone Number : 312-521-2467
Provider Enumeration Date : 02/14/2017
Last Update Date : 02/14/2017

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