Provider Demographics
NPI:1649596313
Name:CENTER HOME FOR HISPANIC ELDERLY, LLC
Entity Type:Organization
Organization Name:CENTER HOME FOR HISPANIC ELDERLY, LLC
Other - Org Name:CENTER HOME FOR HISPANIC ELDERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-521-2467
Mailing Address - Street 1:1401 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1602
Mailing Address - Country:US
Mailing Address - Phone:773-782-8700
Mailing Address - Fax:773-276-0465
Practice Address - Street 1:1401 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1602
Practice Address - Country:US
Practice Address - Phone:773-782-8700
Practice Address - Fax:773-276-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146062Medicare Oscar/Certification