CHURCHVIEW SUPPORTIVE LIVING COMMUNITY NPI 1003002650

Assisted Living Facility in Chicago, IL

About CHURCHVIEW SUPPORTIVE LIVING COMMUNITY

Churchview Supportive Living Community is a provider in Chicago, IL. The NPI number assigned to this provider is 1003002650. The practitioner's primary taxonomy code is Assisted Living Facility (310400000X). The provider is registered as an organization and their NPI record was last updated 10 years ago.

NPI1003002650 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameCHURCHVIEW SUPPORTIVE LIVING COMMUNITY
Provider Location Address2626 W 63RD ST CHICAGO, IL 60629 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address2626 W 63RD ST CHICAGO, IL 60629 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date09-18-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date04-20-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

CHURCHVIEW SUPPORTIVE LIVING COMMUNITY
2626 W 63RD ST
CHICAGO, IL
ZIP 60629
Phone: (773) 471-4444
Fax: (773) 471-3935
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Mailing Address

CHURCHVIEW SUPPORTIVE LIVING COMMUNITY
2626 W 63RD ST
CHICAGO, IL
ZIP 60629
Phone: (773) 471-4444
Fax: (773) 471-3935

Primary Taxonomy

Taxonomy Code310400000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
License No.0=========001
License StateIL
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

Authorized Official NameMS. LAURA KELLY Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleADMINISTRATOR
Authorized Official Phone(773) 471-4444

Map Location


CHURCHVIEW SUPPORTIVE LIVING COMMUNITY address is 2626 W 63RD ST CHICAGO, IL 60629