NPI 1962954099

State of Illinois Department of Human Services

Organisation Adult Care Home Facility Chicago, IL

Practice location

Address: 10724 S Indiana Ave, Chicago, IL 60628-3615
Phone: (312) 513-4566

Authorised official

Name: Natasha Craig
Title: Cna / Home Health Aid
Phone: (312) 513-4566

Registered specialties

Adult Care Home Facility Primary

Nursing & Custodial Care Facilities Taxonomy 311ZA0620X Licence 0971 (IL)

Other Custodial Care Facility providers in Illinois →

Registry record

NPI: 1962954099
Entity type: Organization
NPI issued: 24 Oct 2016
Record last updated: 24 Oct 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.