Logan Square Supportive Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LOGAN SQUARE SUPPORTIVE LIVING LLC

Practice address

1900 N Karlov Ave
Chicago, IL 60639-4980

Phone

(773) 252-9941

NPI assigned

Jan 25, 2023

Organization subpart

No

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

Authorized official

Name

Michael Zahtz

Title

Authorized Official

Phone

(773) 252-9941

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1427764315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6444 N RIDGEWAY AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607124028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 N KARLOV AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394980",
            "telephone_number": "773-252-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN SQUARE SUPPORTIVE LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "ZAHTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "773-252-9941"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.