MEDICARE: WESTWOOD VILLAGE NURSING AND REHABILITATION CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1437856739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTWOOD VILLAGE NURSING AND REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	8707 SKOKIE BLVD STE 104
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-2200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3310
Country	:	US
Telephone Number	:	773-274-7705
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	DAVID MASHIACH
Credential	:
Telephone Number	:	312-791-0035

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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