Provider Demographics
NPI:1033115571
Name:CENTRAL HOME INC
Entity type:Organization
Organization Name:CENTRAL HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-7484
Mailing Address - Street 1:2450 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1316
Mailing Address - Country:US
Mailing Address - Phone:773-889-1333
Mailing Address - Fax:773-889-1516
Practice Address - Street 1:2450 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1316
Practice Address - Country:US
Practice Address - Phone:773-889-1333
Practice Address - Fax:773-889-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000019364314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1142OtherBLUECROSS BLUESHIELD
IL=========001Medicaid
IL=========801Medicaid
IL1094490001Medicare NSC
IL145648Medicare ID - Type UnspecifiedMEDICARE