Montclare Senior Residences SLF of Lawndale LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MONTCLARE SENIOR RESIDENCES SLF OF LAWNDALE LLC

Practice address

4339 West 18TH Place
Chicago, IL 60623

Phone

(773) 277-0288

Fax

(773) 277-0312

NPI assigned

Dec 29, 2016

Organization subpart

No

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

Authorized official

Name

Joellen Bleavins

Title

President of Management Agent

Phone

(815) 935-1992

Specialties & licenses 1

Addresses

Other names 1

• Montclare Senior Residences SLF of Lawndale Doing business as

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1922543917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4339 WEST 18TH PLACE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60623",
            "telephone_number": "773-277-0288",
            "fax_number": "773-277-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4339 WEST 18TH PLACE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60623",
            "telephone_number": "773-277-0288",
            "fax_number": "773-277-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLARE SENIOR RESIDENCES SLF OF LAWNDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "BLEAVINS",
        "authorized_official_first_name": "JOELLEN",
        "authorized_official_title_or_position": "PRESIDENT OF MANAGEMENT AGENT",
        "authorized_official_telephone_number": "815-935-1992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montclare Senior Residences SLF of Lawndale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bailey Montano
• Jerico Montano, PT
• Amanda J Montbriand, DPT
• Meghan Montcalm, RN, IBCLC
• Montclare Dental Inc
• Carolyn Monteagudo, LSW
• Tamara Montealegre, LCSW
• Gabriella Monteiro, PA-C
• Doug Alan Monteith, M.D.
• Sarah Emily Monteith, M.S.

• 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 Dec 29, 2016; 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.