Provider Demographics
NPI:1003002650
Name:CHURCHVIEW SUPPORTIVE LIVING COMMUNITY
Entity Type:Organization
Organization Name:CHURCHVIEW SUPPORTIVE LIVING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-471-4444
Mailing Address - Street 1:2626 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1655
Mailing Address - Country:US
Mailing Address - Phone:773-471-4444
Mailing Address - Fax:773-471-3935
Practice Address - Street 1:2626 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1655
Practice Address - Country:US
Practice Address - Phone:773-471-4444
Practice Address - Fax:773-471-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility