Provider Demographics
NPI:1093226847
Name:MADISON WI BG OPCO LLC
Entity Type:Organization
Organization Name:MADISON WI BG OPCO LLC
Other - Org Name:CHEROKEE PARK PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-725-7000
Mailing Address - Street 1:330 N WABASH AVE STE 3700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7605
Mailing Address - Country:US
Mailing Address - Phone:312-725-7041
Mailing Address - Fax:
Practice Address - Street 1:1601 WHEELER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7056
Practice Address - Country:US
Practice Address - Phone:608-291-4440
Practice Address - Fax:312-725-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility