Healthcare Provider Details

I. General information

NPI: 1366781502
Provider Name (Legal Business Name): PARAMOUNT OF OAK PARK REHABILITATION & NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N HARLEM AVE
OAK PARK IL
60302-1805
US

IV. Provider business mailing address

625 N HARLEM AVE
OAK PARK IL
60302-1805
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-5966
  • Fax: 708-848-1257
Mailing address:
  • Phone: 708-848-5966
  • Fax: 708-848-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID WENGROW
Title or Position: MANAGER
Credential:
Phone: 773-304-8863