MEDICARE: WILLOW OF MARENGO, INC

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	0041657	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6003180	OTHER	IL	FACILITY ID

General Provider Information

NPI Number	:	1780789693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW OF MARENGO, INC

Provider Business Mailing Address
First Line	:	546 E GRANT HWY
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-3346
Country	:	US
Telephone Number	:	815-568-8322
Fax Number	:	815-568-0135

Provider Business Practice Location Address
First Line	:	546 E GRANT HWY
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-3346
Country	:	US
Telephone Number	:	815-568-8322
Fax Number	:	815-568-0135

Authorized Official
Title or Position	:	COO
Name	:	MR. JOSEPH BRANDMAN
Credential	:
Telephone Number	:	773-338-4400

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	12/24/2025

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