NINE FORTY CULLOM CORPORATION NPI 1912998188

NPI Information

NINE FORTY CULLOM CORPORATION is an intermediate care facility mental illness in Chicago, IL. The provider is a nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. NINE FORTY CULLOM CORPORATION NPI is 1912998188. The provider is registered as an organization entity type.
The provider Is Doing Business As Mado Healthcare - Buena Park.

The provider's business location address is:

940 W CULLOM AVE
CHICAGO, IL
ZIP 60613
Phone: (773) 525-9000
Fax: (773) 525-8016

The provider's authorized official is Peter J Obrien .
The authorized official title is President and has the following contact phone number (312) 787-9400.

The CLIA number assigned to this NPI record is 14D0878840 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/4/2005 and was last updated on 4/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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