MEDICARE: NORWOOD CROSSING 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	314000000X	Skilled Nursing Facility	1761603	IL
2	310400000X	Assisted Living Facility	0012237	IL
3	314000000X	Skilled Nursing Facility	0012237	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1605397	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1477540417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORWOOD CROSSING ASSOCIATION

Provider Business Mailing Address
First Line	:	6016 N NINA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-2439
Country	:	US
Telephone Number	:	773-631-4856
Fax Number	:	773-631-4850

Provider Business Practice Location Address
First Line	:	6016 N NINA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-2439
Country	:	US
Telephone Number	:	773-631-4856
Fax Number	:	773-631-4850

Authorized Official
Title or Position	:	CFO
Name	:	MRS. GAIL ANN PRETE
Credential	:
Telephone Number	:	773-577-5325

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	05/18/2010

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