Provider Demographics
NPI:1821439738
Name:MERCY CIRCLE
Entity Type:Organization
Organization Name:MERCY CIRCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:VON GOEBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-617-1447
Mailing Address - Street 1:3659 W 99TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655
Mailing Address - Country:US
Mailing Address - Phone:773-253-3600
Mailing Address - Fax:773-253-3700
Practice Address - Street 1:3659 W. 99TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655
Practice Address - Country:US
Practice Address - Phone:773-253-3600
Practice Address - Fax:773-253-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2017-01-23
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
IL146174Medicare PIN