National Provider Identifier Database

17400 S KEDZIE AVE LLC
Assisted Living Facility

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.


Contact Information

17400 S KEDZIE AVE LLC
17400 KEDZIE AVE
HAZEL CREST, IL60429-1600
Phone: 618-780-3256
Fax:
Website:
Specialty Taxonomy Code
* Assisted Living Facility 310400000X
Alzheimer Center /Dementia Center/Dementia Special Care Unit 311500000X

* Indicates primary specialty

NPI Profile & details for 17400 S KEDZIE AVE LLC

NPI Number 1578321311
Legal business name
LBN
17400 S KEDZIE AVE LLC
Authorized official ASHLEY PETERSON - (VICE PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 03/07/2024
Last updated 05/17/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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