Healthcare Provider Details

I. General information

NPI: 1376863019
Provider Name (Legal Business Name): VILLA AT WINDSOR PARK NURSING AND LIVING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 E 75TH ST
CHICAGO IL
60649-3835
US

IV. Provider business mailing address

7040 N RIDGEWAY AVE
LINCOLNWOOD IL
60712-2620
US

V. Phone/Fax

Practice location:
  • Phone: 773-356-9300
  • Fax: 773-356-9384
Mailing address:
  • Phone: 847-679-9797
  • Fax: 847-679-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLICENSE APPLIED FOR
License Number State

VIII. Authorized Official

Name: MENACHEM BERGER
Title or Position: MANAGER
Credential:
Phone: 847-679-9797