Organization
LIFECARE@HOME
Active
Parent organization
MONTGOMERY PLACE
Organization subpart
Yes
Provider details
NPI number
Legal business name
MONTGOMERY PLACE
Authorized official
MR. BOBBY POPE (ADMINISTRATOR)
(774) 447-3601
Entity
Organization
Contact information
Practice address
5550 S SHORE DR, CHICAGO, IL 60637-5051
(773) 358-7438
(773) 752-0056
Mailing address
5550 S SHORE DR, CHICAGO, IL 60637-5051
(773) 358-7438
(773) 752-0056
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
3000305
IL
253Z00000X
In Home Supportive Care Agency
3000305
IL
Other
Enumeration date
11/18/2015
Last updated
06/10/2016
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