Basic Information
| Provider Information | |||||||||
| NPI: | 1336385764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARREN PARK HEALTH AND LIVING CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WARREN PARK HEALTH AND LIVING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3755 CHASE AVE | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600764008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2244702044 | ||||||||
| FaxNumber: | 2244702952 | ||||||||
| Practice Location | |||||||||
| Address1: | 6700 N DAMEN AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606454902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734655000 | ||||||||
| FaxNumber: | 7737435983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2009 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MEEHAN | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ATTORNEY | ||||||||
| AuthorizedOfficialTelephone: | 3125212467 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0050070 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.