Provider Demographics
NPI:1598026676
Name:CHICAGO COMMONS ASSOCIATION
Entity Type:Organization
Organization Name:CHICAGO COMMONS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DHIREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-826-4065
Mailing Address - Street 1:515 E 50TH ST
Mailing Address - Street 2:200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2401
Mailing Address - Country:US
Mailing Address - Phone:773-826-4065
Mailing Address - Fax:773-299-1019
Practice Address - Street 1:515 E 50TH ST
Practice Address - Street 2:200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2401
Practice Address - Country:US
Practice Address - Phone:773-826-4065
Practice Address - Fax:773-299-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL253Z00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========922Medicaid