Provider Demographics
NPI:1952833071
Name:CHI LIVING COMMUNITIES
Entity Type:Organization
Organization Name:CHI LIVING COMMUNITIES
Other - Org Name:CHI FRANCISCAN VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-455-0414
Mailing Address - Street 1:3601 S CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3708
Mailing Address - Country:US
Mailing Address - Phone:414-764-4100
Mailing Address - Fax:414-764-0706
Practice Address - Street 1:5000 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1410
Practice Address - Country:US
Practice Address - Phone:567-455-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIPENDINGMedicare Oscar/Certification