MEDICARE: WPP OH SUB, 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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2958R	OTHER	OH	RCF LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619741741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WPP OH SUB, LLC

Provider Business Mailing Address
First Line	:	200 E COURT ST STE 400
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-3848
Country	:	US
Telephone Number	:	815-935-1992
Fax Number	:	815-935-1992

Provider Business Practice Location Address
First Line	:	3501 EXECUTIVE PKWY
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1321
Country	:	US
Telephone Number	:	419-531-9211
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL PROJECT & BUSINESS INSURA
Name	:	BRIDGETT L FITZGERALD
Credential	:
Telephone Number	:	815-935-1992

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	04/28/2026

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Directions to “WPP OH SUB, LLC ” Practice Location

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