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MADO HEALTHCARE - BUENA PARK
NPI 1912998188
Intermediate Care Facility, Mental Illness in Chicago, IL

Active since November 04, 2005CLIA 14D0878840 · Waiver
940 W CULLOM AVE, CHICAGO, IL 60613(773) 525-9000(773) 525-8016 Get Directions Write a Review

NPPES record last updated: April 15, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mado Healthcare - Buena Park NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADO HEALTHCARE - BUENA PARK (NPI 1912998188) is a healthcare organization registered as an intermediate care facility, mental illness in Chicago, Illinois and active in the NPI registry since November 2005. The organization holds a CLIA Waiver certificate valid through November 7, 2027 and lists Peter J Obrien, President, as its authorized official.

NPPES Registry Identity

NPI1912998188
Entity TypeOrganization
Primary Taxonomy310500000X
Legal Business NameNINE FORTY CULLOM CORPORATION
Location Address940 W CULLOM AVEChicago, IL 60613
Mailing Address405 N Wabash Ave Ste P2wChicago, IL 60611-3541 · (312) 787-9400 · Fax (312) 787-9434
Phone(773) 525-9000
Fax(773) 525-8016
Organization SubpartNo
Authorized OfficialPeter J ObrienPresident · (312) 787-9400
Enumeration DateNovember 4, 2005
Last NPPES UpdateApril 15, 2019
✔ NPI 1912998188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Mental IllnessNursing & Custodial Care Facilities
Taxonomy Code310500000X
License✔ Licensed in IL · 0017178
Definition
A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness.
940 W CULLOM AVE, Chicago, IL 60613
Open in Google Maps ↗

Other Names 1

Doing Business AsMado Healthcare - Buena Park

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0878840

Mado Healthcare - Buena Park · Chicago, IL
Active · expires Nov 7, 2027
CLIA Number14D0878840
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateNovember 8, 2025
Certificate Expiration DateNovember 7, 2027
Laboratory DirectorTina Lott
Laboratory Phone(773) 525-9000
Laboratory LocationMado Healthcare - Buena Park940 West Cullom Avenue, Chicago, IL 60613
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LUTHERAN SOCIAL SERVICES OF ILLINOIS
Clinic/Center (Rehabilitation, Substance Use Disorder)
940 W CULLOM AVE
CHICAGO, IL 60613
Cook County (224) 275-1978

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nine Forty Cullom Corporation's NPI number?

The NPI number for Nine Forty Cullom Corporation is 1912998188. It was assigned to this organization in the NPPES registry on November 4, 2005. The provider is doing business as Mado Healthcare - Buena Park.

Where is Nine Forty Cullom Corporation located?

Nine Forty Cullom Corporation is located at 940 W Cullom Ave, Chicago, IL 60613. The listed phone number is (773) 525-9000.

What is Nine Forty Cullom Corporation's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Mental Illness with taxonomy code 310500000X.

Does Nine Forty Cullom Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0878840) is associated with this NPI, valid through November 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Nine Forty Cullom Corporation was last updated on April 15, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.