Basic Information
| Provider Information | |||||||||
| NPI: | 1891173654 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SYMPHONY ARIA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARIA POST ACUTE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7257 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477456212 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4600 FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | HILLSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601621761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085449933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | HARTMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8477456212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 14-5946 | 01 | MEDICARE ID | OTHER |