Provider Demographics
NPI:1174175830
Name:LAUREATE WEST CHICAGO OPERATIONS LLC
Entity type:Organization
Organization Name:LAUREATE WEST CHICAGO OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-426-8849
Mailing Address - Street 1:13024 BALNTYN CORP PL STE 425
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4420
Mailing Address - Country:US
Mailing Address - Phone:704-426-8849
Mailing Address - Fax:
Practice Address - Street 1:928 JOLIET ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3725
Practice Address - Country:US
Practice Address - Phone:630-231-9292
Practice Address - Fax:630-231-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility