Organization
VERONICA MACK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA MACK #0792-1021 (CNA)
(773) 673-3960
Entity
Organization
Contact information
Practice address
9738 S MERRION AVE, CHICAGO, IL 60617-4846
(773) 673-3960
Mailing address
9738 S MERRION, CHICAGO, IL 60617
(773) 673-3960
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
07921021
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07921021
CNA
—
Enumeration date
09/01/2016
Last updated
09/01/2016
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