Provider Demographics
NPI:1942305321
Name:COMMUNITY FIRST HEALTHCARE OF ILLINOIS, INC
Entity Type:Organization
Organization Name:COMMUNITY FIRST HEALTHCARE OF ILLINOIS, INC
Other - Org Name:COMMUNITY FIRST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-794-8320
Mailing Address - Street 1:5645 WEST ADDISON
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-282-7000
Mailing Address - Fax:
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4403
Practice Address - Country:US
Practice Address - Phone:773-282-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY FIRST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0001719314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0911OtherBLUE CROSS OF IL SNF
IL145548Medicare Oscar/Certification