MEDICARE: BROOKDALE SENIOR LIVING

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	310400000X	Assisted Living Facility	5101776	IL

General Provider Information

NPI Number	:	1447539416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKDALE SENIOR LIVING

Provider Business Mailing Address
First Line	:	3121 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4945
Country	:	US
Telephone Number	:	773-404-9800
Fax Number	:	773-404-7898

Provider Business Practice Location Address
First Line	:	3121 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4945
Country	:	US
Telephone Number	:	773-404-9800
Fax Number	:	773-404-7898

Authorized Official
Title or Position	:	DIRECTOR OF SALES AND MARKETING
Name	:	KRISTINA LISZKIEWICZ
Credential	:
Telephone Number	:	773-832-0886

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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Directions to “BROOKDALE SENIOR LIVING ” Practice Location

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