Organization · NPI-2

4621 Corporation

Skilled Nursing Facility · Chicago, IL

NPI number1871580126
StatusActive
Last updated in NPPESApr 8, 2019

Details

NPI
1871580126
Entity type
Organization (NPI-2)
Legal business name
4621 Corporation
Organization subpart
No
Enumeration date
Oct 3, 2005
Last updated
Apr 8, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing Facility0023770–Yes

Other names

  • Mado Healthcare - Uptown (Doing Business As)

Practice location

4621 N Racine Ave
Chicago, IL 60640-4905

Phone 773-784-2300 · Fax 773-769-4621

Mailing address

405 N Wabash Ave Ste P2w
Chicago, IL 60611-3541

Phone 312-787-9400 · Fax 312-787-9434

Authorized official

Peter J Obrien
President
3127879400

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