Provider Demographics
NPI:1578648028
Name:KINDRED THC CHICAGO, LLC
Entity Type:Organization
Organization Name:KINDRED THC CHICAGO, LLC
Other - Org Name:KINDRED - CHICAGO - CENTRAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:4058 W MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4799
Mailing Address - Country:US
Mailing Address - Phone:773-736-7000
Mailing Address - Fax:773-202-4355
Practice Address - Street 1:4058 W MELROSE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641
Practice Address - Country:US
Practice Address - Phone:773-736-7000
Practice Address - Fax:773-202-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004564282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL195OtherBLUE CROSS
IL=========OtherUNITED HEALTHCARE
IL195OtherBLUE CROSS
IL=========OtherAETNA
IL=========OtherHUMANA
IL=========007Medicaid
IL=========OtherCIGNA
IL=========OtherHUMANA