Provider Demographics
NPI:1477540417
Name:NORWOOD CROSSING ASSOCIATION
Entity Type:Organization
Organization Name:NORWOOD CROSSING ASSOCIATION
Other - Org Name:NORWOOD CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-577-5325
Mailing Address - Street 1:6016 N NINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2439
Mailing Address - Country:US
Mailing Address - Phone:773-631-4856
Mailing Address - Fax:773-631-4850
Practice Address - Street 1:6016 N NINA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2439
Practice Address - Country:US
Practice Address - Phone:773-631-4856
Practice Address - Fax:773-631-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0012237310400000X, 314000000X
IL1761603314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605397OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
145974Medicare ID - Type Unspecified