Provider Demographics
NPI:1023002318
Name:PRESENCE SENIOR SERVICES CHICAGOLAND
Entity Type:Organization
Organization Name:PRESENCE SENIOR SERVICES CHICAGOLAND
Other - Org Name:ASCENSION LIVING SCALABRINI VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CONTRACT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRUMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-441-5866
Mailing Address - Street 1:480 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-1650
Mailing Address - Country:US
Mailing Address - Phone:708-562-0040
Mailing Address - Fax:708-562-6623
Practice Address - Street 1:480 N WOLF RD
Practice Address - Street 2:
Practice Address - City:NORTH LAKE
Practice Address - State:IL
Practice Address - Zip Code:60164
Practice Address - Country:US
Practice Address - Phone:708-562-0040
Practice Address - Fax:708-562-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044792314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1201OtherBLUE CROSS
IL=========008Medicaid
IL145956Medicare Oscar/Certification