Active NPI
Laureate Chicago Operations LLC
- Skilled Nursing Facility
- Chicago, IL
National Provider Identifier
1205488947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- LAUREATE CHICAGO OPERATIONS LLC
- Practice address
- 4314 S Wabash Ave
Chicago, IL 60653-3119 - Phone
- (773) 538-8300
- Fax
- (773) 538-5775
- NPI assigned
- Jul 12, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Shaun Ahmad
- Title
- Manager
- Phone
- (704) 426-8849
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
4314 S Wabash Ave
Chicago, IL 60653-3119
Mailing address
13024 Ballantyne Corporate PL Ste 425
Charlotte, NC 28277-4420
Phone (704) 426-8849
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191025000557 | IL | Part A Provider - Skilled Nursing Facility | 5193057065 | Practice locations: Chicago, IL |
Skilled nursing facility certification: CCN 146164
- Legal name
- LAUREATE CHICAGO OPERATIONS LLC
- Doing business as
- COMMUNITY CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Nov 6, 2012
- Last certification
- Aug 2, 2024
- Beds
- 204
- Ownership / control type
- Corporation
- Most recent change of ownership
- Aug 30, 2019
- Organization structure
- LLC
- Incorporated
- Feb 28, 2019 in DE
- Enrollment address
- 4314 S Wabash Ave
Chicago, IL 60653-3119 - Nursing home name
- ASPYRE OF BRONZEVILLE
- Affiliated entity
- ALIYA HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Aspyre of Bronzeville
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 6, 2012
- Medicare certification status
- Active
- Certified beds
- 204
- Chain
- Aliya Healthcare
- Penalties (3 years)
- 5
National Provider Directory
National Provider DirectoryLocations
13024 Ballantyne Corporate Pl
Ste 425
Charlotte, NC 28277
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Laureate Chicagoland Holdings LLC | 5% Or Greater Direct Ownership Interest | Aug 30, 2019 | 99.9% |
| Kevin Hines | W-2 Managing Employee | Aug 30, 2019 | 100% |
| Kathleen Marie Dempsey | W-2 Managing Employee | Oct 11, 2019 | 100% |
| Shaun Ahmad | Corporate Officer | Aug 30, 2019 | 100% |
Facilities with the same owner 1
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Waukegan, IL
- NPI 1811549579
Laureate Chicagoland Holdings LLC
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562889600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1562889600000",
"number": "1205488947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13024 BALLANTYNE CORPORATE PL STE 425",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282774420",
"telephone_number": "704-426-8849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4314 S WABASH AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606533119",
"telephone_number": "773-538-8300",
"fax_number": "773-538-5775"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAUREATE CHICAGO OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-07-12",
"last_updated": "2019-07-12",
"status": "A",
"authorized_official_last_name": "AHMAD",
"authorized_official_first_name": "SHAUN",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "704-426-8849",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.