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NPI Code Detail

MEDICARE: MISERICORDIA HOME

MEDICARE: MISERICORDIA HOME
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
1315P00000XIntellectual Disabilities Intermediate Care Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13000696OTHERILILLINOISDEPARTMENTOFPUBLICHEALTH

General Provider Information

NPI Number : 1720947088
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISERICORDIA HOME
Provider Business Mailing Address
First Line : 6300 N RIDGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1099
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6300 N RIDGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1099
Country : US
Telephone Number : 773-973-6300
Fax Number :
Authorized Official
Title or Position : SECRETARY/GENERAL COUNSEL
Name : KEVIN KNOLL
Credential :
Telephone Number : 773-273-2729
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Practice Location Address:
6300 N RIDGE AVE
CHICAGO, IL
60660-1099
Practice Phone: 773-973-6300
Practice Fax:
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Practice Location Address:
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1902765274 — MISERICORDIA HOME
Practice Location Address:
6300 N RIDGE AVE
CHICAGO, IL
60660-1099
Practice Phone: 773-973-6300
Practice Fax:
1265391536 — MISERICORDIA HOME
Practice Location Address:
6300 N RIDGE AVE
CHICAGO, IL
60660-1099
Practice Phone: 773-973-6300
Practice Fax:
1124987409 — MISERICORDIA HOME
Practice Location Address:
6300 N RIDGE AVE
CHICAGO, IL
60660-1099
Practice Phone: 773-973-6300
Practice Fax:

Directions to “MISERICORDIA HOME ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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