Healthcare Provider Details

I. General information

NPI: 1245067941
Provider Name (Legal Business Name): GOLDWATER CARE ROSEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S CHAMBERLAIN ST
ROSEVILLE IL
61473-9581
US

IV. Provider business mailing address

4655 W CHASE AVE
LINCOLNWOOD IL
60712-1605
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-8113
  • Fax:
Mailing address:
  • Phone: 847-262-3800
  • Fax:

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: JENNIFER SPECTOR
Title or Position: VP OF REVENUE CYCLE MANAGEMENT
Credential:
Phone: 847-262-3800