Provider Demographics
NPI:1689737470
Name:THE SELFHELP HOME, INC
Entity Type:Organization
Organization Name:THE SELFHELP HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:773-271-0300
Mailing Address - Street 1:908 W ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3806
Mailing Address - Country:US
Mailing Address - Phone:773-271-0300
Mailing Address - Fax:773-271-6300
Practice Address - Street 1:908 W ARGYLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3806
Practice Address - Country:US
Practice Address - Phone:773-271-0300
Practice Address - Fax:773-271-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0018580314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036221002001Medicaid
IL146009Medicare Oscar/Certification