Provider Demographics
NPI:1902167349
Name:CLARE PROPCO LLC
Entity Type:Organization
Organization Name:CLARE PROPCO LLC
Other - Org Name:TERRACES AT THE CLARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4500
Mailing Address - Street 1:55 E PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2535
Mailing Address - Country:US
Mailing Address - Phone:312-951-5690
Mailing Address - Fax:312-784-8016
Practice Address - Street 1:55 E PEARSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2535
Practice Address - Country:US
Practice Address - Phone:312-951-5690
Practice Address - Fax:312-784-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146141Medicare Oscar/Certification