Provider Demographics
NPI:1598644130
Name:CITADEL AT SAINT ANNE PLACE LLC
Entity type:Organization
Organization Name:CITADEL AT SAINT ANNE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-470-2044
Mailing Address - Street 1:3701 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2615
Mailing Address - Country:US
Mailing Address - Phone:224-470-2044
Mailing Address - Fax:
Practice Address - Street 1:4405 HIGHCREST RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1452
Practice Address - Country:US
Practice Address - Phone:815-229-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility