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NPI Code Detail

MEDICARE: DUPAGE CONVALESCENT CENTER

MEDICARE: DUPAGE CONVALESCENT CENTER
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
1314000000XSkilled Nursing Facility0008201IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136600651002OTHERILROOM AND BOARD

General Provider Information

NPI Number : 1952563207
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUPAGE CONVALESCENT CENTER
Provider Business Mailing Address
First Line : 400 N COUNTY FARM RD
Second Line :
City : WHEATON
State : IL
Zip : 60187-3908
Country : US
Telephone Number : 630-784-4201
Fax Number : 630-784-4203
Provider Business Practice Location Address
First Line : 400 N COUNTY FARM RD
Second Line :
City : WHEATON
State : IL
Zip : 60187-3908
Country : US
Telephone Number : 630-784-4201
Fax Number : 630-784-4203
Authorized Official
Title or Position : ADMINISTRATOR
Name : JENNIFER M ULMER
Credential : LNHA
Telephone Number : 630-784-4202
Provider Enumeration Date : 06/27/2008
Last Update Date : 01/14/2015

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Directions to “DUPAGE CONVALESCENT CENTER ” Practice Location

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