Clark Manor Convalescent Center, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0038596 Issued in IL

Legal business name

CLARK MANOR CONVALESCENT CENTER, INC

Practice address

7433 N Clark St
Chicago, IL 60626-1619

Phone

(773) 338-8778

Fax

(773) 764-7449

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jack Schnell

Title

President

Phone

(773) 338-8778

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891740460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7433 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606261619",
            "telephone_number": "773-338-8778",
            "fax_number": "773-764-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7433 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606261619",
            "telephone_number": "773-338-8778",
            "fax_number": "773-764-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK MANOR CONVALESCENT CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHNELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-338-8778",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0038596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claridge Imperial, LTD
• Claridge Ivy, LTD
• Clarion Voice & Speech PLLC
• Clarity Clinic PLLC
• Clark Dental Office LTD
• Clark Pharmacy Inc
• Clark Skilled Nursing Facility LLC
• Allison Clark Young, APN
• Cynthia June Clark-Bumgarner, CRNA
• Cordia Marie Clark-White, MD

• 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.