MEDICARE: CARLYLE HEALTHCARE & SENIOR LIVING, 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1891462768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLYLE HEALTHCARE & SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	8131 MONTICELLO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3325
Country	:	US
Telephone Number	:	773-945-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 CLINTON ST
Second Line	:
City	:	CARLYLE
State	:	IL
Zip	:	62231-1503
Country	:	US
Telephone Number	:	618-594-3112
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KEVIN CHANKIN
Credential	:
Telephone Number	:	618-594-3112

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	08/27/2021

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