Healthcare Provider Details
I. General information
NPI: 1538977517
Provider Name (Legal Business Name): RYZE AT HOMEWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
19000 HALSTED ST
HOMEWOOD IL
60430-4204
US
IV. Provider business mailing address
3515 HOWARD ST STE 1001
SKOKIE IL
60076-4001
US
V. Phone/Fax
- Phone: 708-957-9200
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 314000000X |
| Taxonomy | Skilled Nursing Facility |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
EFRIAM
WEINFELD
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 708-957-9200