Healthcare Provider Details

I. General information

NPI: 1821087008
Provider Name (Legal Business Name): WATERFORD NURSING & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 N SHERIDAN RD
CHICAGO IL
60626-1818
US

IV. Provider business mailing address

7445 N SHERIDAN RD
CHICAGO IL
60626-1818
US

V. Phone/Fax

Practice location:
  • Phone: 773-338-3300
  • Fax: 773-338-5868
Mailing address:
  • Phone: 773-338-3300
  • Fax: 773-338-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0038612
License Number StateIL

VIII. Authorized Official

Name: MRS. SYLVIA Y HERLIHY
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 773-338-3300