Provider Demographics
NPI:1174652176
Name:LITTLE SISTERS OF THE POOR CHICAGO INC
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR CHICAGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-935-9600
Mailing Address - Street 1:2325 N LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3112
Mailing Address - Country:US
Mailing Address - Phone:773-935-9600
Mailing Address - Fax:773-935-4291
Practice Address - Street 1:2325 N LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3112
Practice Address - Country:US
Practice Address - Phone:773-935-9600
Practice Address - Fax:773-935-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6005563Medicaid
IL6005563Medicaid