MONTGOMERY PLACE NPI 1811018112

Nursing Facility/Intermediate Care Facility in Chicago, IL

Organization Nursing Facility/Intermediate Care Facil... CLIA Record

About MONTGOMERY PLACE

Montgomery Place is a provider established in Chicago, Illinois specializing in nursing facility/intermediate care facility. The NPI number of Montgomery Place is 1811018112 and was assigned on April 2007. The practitioner's primary taxonomy code is 313M00000X with license number 0037515 (IL). The provider is registered as an organization and their NPI record was last updated 8 years ago.
The authorized official of this NPI record is Mr. Michael R. Apa (Executive Director)

NPI

1811018112

Provider NameMONTGOMERY PLACE
Provider Location Address5550 S SHORE DR CHICAGO, IL 60637
Provider Mailing Address5550 S SHORE DR CHICAGO, IL 60637
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date04-03-2007
Last Update Date10-25-2011

Primary Taxonomy

Taxonomy Code313M00000X
ClassificationNursing Facility/Intermediate Care Facility
TypeNursing & Custodial Care Facilities
License No.0037515
License StateIL
Taxonomy DescriptionAn institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

Business Address

MONTGOMERY PLACE
5550 S SHORE DR
CHICAGO, IL
ZIP 60637
Phone: (773) 753-4100
Fax: (773) 752-0056

Get Directions

Mailing Address

MONTGOMERY PLACE
5550 S SHORE DR
CHICAGO, IL
ZIP 60637
Phone: (773) 753-4100
Fax: (773) 752-0056

Authorized Official

Authorized Official NameMR. MICHAEL R. APA
Authorized Official TitleEXECUTIVE DIRECTOR
Authorized Official Phone(773) 753-4096

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates.

CLIA Number14D0895395
Facility TypeSKILLED NURSING/NURSING FACILITY
Certificate TypeWaiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
145748MEDICARE OSCAR/CERTIFICATION (06)
=========001MEDICAID (05)IL

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1275907990LIFECARE@HOME
Organization
Nursing Care5550 S SHORE DR
CHICAGO, IL 60637
(773) 358-7438
1487653788MISS LAURIEANN CHUTIS LCSW
Individual
Social Worker (Clinical)5550 S SHORE DR SUITE 1107
CHICAGO, IL 60637
(773) 753-4638
1679873111MONTGOMERY PLACE
Organization
Clinic/Center (Physical Therapy)5550 S SHORE DR
CHICAGO, IL 60637
(773) 753-4100
1699224998 MICHAEL ESPOSITO
Individual
Physical Therapy Assistant5550 S SHORE DR
CHICAGO, IL 60637
(815) 382-8966
1962601112 IRENE CHEUNG-CHAN DPT/MBA
Individual
Physical Therapist5550 S SHORE DR
CHICAGO, IL 60637
(773) 753-4111

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider 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 Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type 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)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart 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.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary 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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

Previous NPI
1811018104
Next NPI
1811018120