MEDICARE: GENERATIONS AT COLUMBUS PARK,INC

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	0037960	IL

General Provider Information

NPI Number	:	1679578041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS AT COLUMBUS PARK,INC

Provider Business Mailing Address
First Line	:	6840 N LINCOLN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2628
Country	:	US
Telephone Number	:	847-675-7979
Fax Number	:	847-674-5267

Provider Business Practice Location Address
First Line	:	901 S AUSTIN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5304
Country	:	US
Telephone Number	:	773-287-5959
Fax Number	:	773-287-7909

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. THOMAS WINTER
Credential	:	CPA
Telephone Number	:	847-675-7979

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/12/2016

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