Organization
4621 CORPORATION
Active
Other names
MADO HEALTHCARE - UPTOWN
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J OBRIEN SR. (PRESIDENT)
(312) 787-9400
Entity
Organization
Contact information
Practice address
4621 N RACINE AVE, CHICAGO, IL 60640-4905
(773) 784-2300
(773) 769-4621
Mailing address
405 N WABASH AVE STE P2W, CHICAGO, IL 60611-3541
(312) 787-9400
(312) 787-9434
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0023770
—
Other
Enumeration date
10/03/2005
Last updated
04/08/2019
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