Basic Information
| Provider Information | |||||||||
| NPI: | 1629265988 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VICTORY CENTRE OF ROSELAND LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 S WACKER DR STE 1010 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606067413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128370701 | ||||||||
| FaxNumber: | 3128370728 | ||||||||
| Practice Location | |||||||||
| Address1: | 10450 S. MICHIGAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606282751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734686400 | ||||||||
| FaxNumber: | 7739873907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | BECHT | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | RISK MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3128370710 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PATHWAY MANAGEMENT, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 310400000X | IL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.