Basic Information
| Provider Information | |||||||||
| NPI: | 1225109564 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONROE CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONROE PAVILION HEALTH AND TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7257 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479332600 | ||||||||
| FaxNumber: | 8479330686 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 W MONROE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606072512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126664090 | ||||||||
| FaxNumber: | 3124210134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RUDD | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICARE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8479332600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | IL | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.