Healthcare Provider Details

I. General information

NPI: 1942297775
Provider Name (Legal Business Name): WENTWORTH REHABILITATION AND HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 69TH ST
CHICAGO IL
60621-3719
US

IV. Provider business mailing address

4200 W PETERSON AVE SUITE 140
CHICAGO IL
60646-6074
US

V. Phone/Fax

Practice location:
  • Phone: 773-487-1200
  • Fax: 773-487-4782
Mailing address:
  • Phone: 773-286-6622
  • Fax: 773-286-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0026435
License Number StateIL

VIII. Authorized Official

Name: JOHN AVELINO
Title or Position: ACCOUNTS RECIEVABLE MANAGER
Credential:
Phone: 773-724-6376