Jackson Square Skilled Nursing Aand Living

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0039834 Issued in IL

Legal business name

JACKSON SQUARE SKILLED NURSING AAND LIVING

Practice address

5130 W Jackson Blvd
Chicago, IL 60644-4332

Phone

(773) 921-8000

Fax

(773) 921-3980

NPI assigned

Jun 22, 2009

Last updated

Jun 22, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Reuven Levitin

Title

Patient Accounts Manager

Phone

(847) 745-6240

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Jackson Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jackson Corp

  dba Jackson Square Nursing & Rehab Center

  • Skilled Nursing Facility
  • Chicago, IL
  • NPI 1588816623
  NPD tax ID

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245628800000",
    "number": "1356578900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7257 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121810",
            "telephone_number": "847-933-2600",
            "fax_number": "847-933-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606444332",
            "telephone_number": "773-921-8000",
            "fax_number": "773-921-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON SQUARE SKILLED NURSING AAND LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2009-06-22",
        "status": "A",
        "authorized_official_last_name": "LEVITIN",
        "authorized_official_first_name": "REUVEN",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "847-745-6240"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0039834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1740351972",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Park Hospital
• Jackson Park Hospital Foundation
• Jackson Park Hospital Foundation
• Jackson Park SLF, LLC
• Jackson Park Suppotive Living
• Anais Karel Jackson-Gonzalez
• Kathryn Carly Jackson-Griffin, MA, NCC
• Jennifer L Jackson-Laurent, M.A. CCC-SLP
• Jameera Jahaan Jackson-Reyes, LPC
• Lakecia Jackson-Rooks, OTRL, D.T.

• Oxygen Equipment & Supplies (DME) in Chicago, IL
• Providers in Chicago, IL by specialty
• Oxygen Equipment & Supplies (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; 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.