St Agnes Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0027870 Issued in IL

Legal business name

ST AGNES MANOR INC

Practice address

1725 S Wabash Ave
Chicago, IL 60616-1219

Phone

(312) 922-2777

Fax

(312) 939-1820

NPI assigned

Jan 30, 2006

Last updated

Aug 22, 2020By 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

Mr. Peter J O'Brien

Title

Vice President

Phone

(312) 787-9400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699746420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 N WELLS ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606101307",
            "telephone_number": "312-787-9400",
            "fax_number": "312-787-9434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 S WABASH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606161219",
            "telephone_number": "312-922-2777",
            "fax_number": "312-939-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST AGNES MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "312-787-9400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0027870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.