Healthcare Provider Details

I. General information

NPI: 1528054350
Provider Name (Legal Business Name): WESTWOOD MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 W TOUHY AVE
CHICAGO IL
60645-3310
US

IV. Provider business mailing address

2444 W TOUHY AVE
CHICAGO IL
60645-3310
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-7705
  • Fax: 773-274-6173
Mailing address:
  • Phone: 773-274-7705
  • Fax: 773-274-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5249
License Number StateIL

VIII. Authorized Official

Name: DR. JOSEPH LIBERMAN
Title or Position: ADMINISTRATOR
Credential: PH.D.
Phone: 773-274-7705