Beth Anne Extended Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BETH ANNE EXTENDED LIVING

Practice address

1143 N Lavergne Ave
Chicago, IL 60651-3117

Phone

(773) 287-2711

Fax

(773) 473-7871

NPI assigned

Jan 29, 2008

Organization subpart

Yes

Parent organization

BETHEL NEW LIFE, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven D. McCullough, MBA

Title

President and Ceo

Phone

(773) 473-7870

Specialties & licenses 1

Addresses

Other names 1

• Beth Anne Place Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1194902353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 N LAVERGNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606513117",
            "telephone_number": "773-287-2711",
            "fax_number": "773-473-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 N LAVERGNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606513117",
            "telephone_number": "773-287-2711",
            "fax_number": "773-473-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH ANNE EXTENDED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETHEL NEW LIFE, INC.",
        "enumeration_date": "2008-01-29",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "773-473-7870",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beth Anne Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Chicago, IL
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.