Provider Demographics
NPI:1881355345
Name:PATHWAY LA GRANGE PROPERTY OWNER, LLC
Entity type:Organization
Organization Name:PATHWAY LA GRANGE PROPERTY OWNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTENJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-837-0710
Mailing Address - Street 1:222 S RIVERSIDE PLZ FL 20
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5808
Mailing Address - Country:US
Mailing Address - Phone:312-837-0701
Mailing Address - Fax:
Practice Address - Street 1:35 SHAWMUT AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-8648
Practice Address - Country:US
Practice Address - Phone:708-206-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5107393OtherIDPH LICENSE NUMBER