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NPI Code Detail

MEDICARE: MAYFIELD CARE CENTER, INC.

MEDICARE: MAYFIELD CARE CENTER, 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
1314000000XSkilled Nursing Facility0029660IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11110OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1780753269
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAYFIELD CARE CENTER, INC.
Provider Business Mailing Address
First Line : 3553 W PETERSON AVE
Second Line : SUITE 300
City : CHICAGO
State : IL
Zip : 60659-3200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5905 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-2845
Country : US
Telephone Number : 773-261-7074
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : JOSHUA WEINSTEIN
Credential :
Telephone Number : 773-463-1313
Provider Enumeration Date : 11/07/2006
Last Update Date : 08/22/2020

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