Provider Demographics
NPI:1891367330
Name:ILLINOIS VETERANS HOME AT CHICAGO
Entity Type:Organization
Organization Name:ILLINOIS VETERANS HOME AT CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:T'KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILER-WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-628-5905
Mailing Address - Street 1:4250 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1417
Practice Address - Country:US
Practice Address - Phone:773-794-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities