Healthcare Provider Details

I. General information

NPI: 1710002035
Provider Name (Legal Business Name): WHEATON CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MANCHESTER RD
WHEATON IL
60187-4760
US

IV. Provider business mailing address

1325 MANCHESTER RD
WHEATON IL
60187-4760
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-2500
  • Fax: 630-668-0232
Mailing address:
  • Phone: 630-668-2500
  • Fax: 630-668-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0039115
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0039115
License Number StateIL

VIII. Authorized Official

Name: JOE ZIMMERMAN
Title or Position: CEO
Credential:
Phone: 847-905-4000