Provider Demographics
NPI:1871678334
Name:KINDRED THC CHICAGO, LLC
Entity Type:Organization
Organization Name:KINDRED THC CHICAGO, LLC
Other - Org Name:KINDRED HOSPITAL - CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:2544 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1537
Mailing Address - Country:US
Mailing Address - Phone:773-267-2622
Mailing Address - Fax:773-267-2685
Practice Address - Street 1:2544 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-267-2622
Practice Address - Fax:773-267-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X
IL0004937282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL106OtherBLUE CROSS
IL106OtherBLUE CROSS
IL=========OtherAETNA
IL=========OtherUNICARE
IL=========OtherHUMANA
IL=========OtherUNITED HEALTHCARE
IL=========005Medicaid
IL=========005Medicaid