Healthcare Provider Details

I. General information

NPI: 1497723464
Provider Name (Legal Business Name): WYNDEMERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 MANCHESTER RD
WHEATON IL
60187-4580
US

IV. Provider business mailing address

2180 MANCHESTER RD
WHEATON IL
60187-4580
US

V. Phone/Fax

Practice location:
  • Phone: 630-681-4200
  • Fax:
Mailing address:
  • Phone: 630-681-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0050674
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number41426
License Number StateIL

VIII. Authorized Official

Name: JUDI L BUXO
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 515-875-4500