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NPI Code Detail

MEDICARE: MONTCLAIR SENIOR LIVING AND MEMORY CARE LLC

MEDICARE: MONTCLAIR SENIOR LIVING AND MEMORY CARE 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
1376K00000XNurse's Aide

General Provider Information

NPI Number : 1649139288
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTCLAIR SENIOR LIVING AND MEMORY CARE LLC
Provider Business Mailing Address
First Line : 550 E DEVON AVE STE 110
Second Line :
City : ITASCA
State : IL
Zip : 60143-2637
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5520 LINCOLN AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3416
Country : US
Telephone Number : 224-388-1439
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : HARDIK PATEL
Credential :
Telephone Number : 224-388-1439
Provider Enumeration Date : 01/20/2026
Last Update Date : 01/20/2026

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