17400 S Kedzie Ave LLC
NPI #1578321311 in Hazel Crest, Illinois
Provider Information
- NPI Number
- 1578321311
- Entity Type
- Organization
- Organization Name
- 17400 S Kedzie Ave LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Mar 7, 2024
- Last Updated
- May 17, 2024
Practice Location
- Address
- 17400 KEDZIE AVE
- City
- Hazel Crest
- State
- Illinois
- ZIP Code
- 60429-1600
- Phone
- (618) 780-3256
Authorized Official
- Name
- ASHLEY PETERSON
- Title
- VICE PRESIDENT
- Phone
- (813) 415-7589
Specialties & Taxonomy Codes
| Specialty |
|---|
| Alzheimer Center (Dementia Center) |
| Assisted Living Facility |
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