Provider Demographics
NPI:1508922683
Name:THE OLD PEOPLE'S HOME OF THE CITY OF CHICAGO
Entity Type:Organization
Organization Name:THE OLD PEOPLE'S HOME OF THE CITY OF CHICAGO
Other - Org Name:THE ADMIRAL AT THE LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICHACEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-561-2900
Mailing Address - Street 1:1630 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:773-561-2900
Mailing Address - Fax:773-561-2573
Practice Address - Street 1:909 W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6481
Practice Address - Country:US
Practice Address - Phone:773-654-5077
Practice Address - Fax:773-561-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility