Provider Demographics
NPI:1760921167
Name:MAYFIELD CARE CENTER LLC
Entity Type:Organization
Organization Name:MAYFIELD CARE CENTER LLC
Other - Org Name:MAYFIELD CARE CENTER
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:ESQ
Authorized Official - Phone:312-521-2467
Mailing Address - Street 1:5905 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2845
Mailing Address - Country:US
Mailing Address - Phone:773-261-7074
Mailing Address - Fax:773-261-7330
Practice Address - Street 1:5905 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2845
Practice Address - Country:US
Practice Address - Phone:773-261-7074
Practice Address - Fax:773-261-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-5885Medicare PIN