Provider Demographics
NPI:1235321423
Name:FRIEDMAN PLACE
Entity Type:Organization
Organization Name:FRIEDMAN PLACE
Other - Org Name:MAPLEWOOD HOUSING FOR THE VISUALLY IMPAIRED
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:FARNAM
Authorized Official - Last Name:LAGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-989-9800
Mailing Address - Street 1:5527 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6881
Mailing Address - Country:US
Mailing Address - Phone:773-989-9800
Mailing Address - Fax:773-989-4889
Practice Address - Street 1:5527 N MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6881
Practice Address - Country:US
Practice Address - Phone:773-989-9800
Practice Address - Fax:773-989-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid