Provider Demographics
NPI:1730173881
Name:PRESENCE SENIOR SERVICES CHICAGOLAND
Entity type:Organization
Organization Name:PRESENCE SENIOR SERVICES CHICAGOLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-3500
Mailing Address - Street 1:7370 W TALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3751
Mailing Address - Country:US
Mailing Address - Phone:773-594-7400
Mailing Address - Fax:773-594-7402
Practice Address - Street 1:7370 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3751
Practice Address - Country:US
Practice Address - Phone:773-594-7400
Practice Address - Fax:773-594-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044354314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1183OtherBLUE CROSS
1183OtherBLUE CROSS
IL=========005Medicaid