MEDICARE: PEARL OF MONTCLARE, 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
1	313M00000X	Nursing Facility/Intermediate Care Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1548974629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL OF MONTCLARE, LLC

Provider Business Mailing Address
First Line	:	4711 GOLF RD STE 200
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1236
Country	:	US
Telephone Number	:	847-933-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 N NORDICA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4726
Country	:	US
Telephone Number	:	773-622-6144
Fax Number	:	773-622-8261

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	EITAN ZEFFREN
Credential	:
Telephone Number	:	773-622-6144

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	07/07/2023

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