Healthcare Provider Details

I. General information

NPI: 1003805672
Provider Name (Legal Business Name): WESTMONT CONVALESCENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 S CASS AVE
WESTMONT IL
60559-3200
US

IV. Provider business mailing address

6501 S CASS AVE
WESTMONT IL
60559-3200
US

V. Phone/Fax

Practice location:
  • Phone: 630-960-2026
  • Fax: 630-724-0245
Mailing address:
  • Phone: 630-960-2026
  • Fax: 630-724-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0030015
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID CHEPLOWITZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-960-2026