Organization
LOGAN SQUARE SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ZAHTZ (AUTHORIZED OFFICIAL)
(773) 252-9941
Entity
Organization
Contact information
Practice address
1900 N KARLOV AVE, CHICAGO, IL 60639-4980
(773) 252-9941
Mailing address
6444 N RIDGEWAY AVE, LINCOLNWOOD, IL 60712-4028
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/25/2023
Last updated
01/25/2023
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