Healthcare Provider Details

I. General information

NPI: 1154503597
Provider Name (Legal Business Name): PHWD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S GILES AVE
CHICAGO IL
60653-1106
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 312-326-2000
  • Fax: 312-326-5753
Mailing address:
  • Phone: 847-329-4100
  • Fax: 847-329-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0020404
License Number StateIL

VIII. Authorized Official

Name: MS. MARALEE RUNGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-329-4100