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General NPI Number Information
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NPI Number | 1366781502
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Entity Type | Organization
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Legal Business Name | PARAMOUNT OF OAK PARK REHABILITATION & NURSING CENTER LLC
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 625 N HARLEM AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1805
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Country | US
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Telephone | 708-848-5966
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Fax | 708-848-1257
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Provider Business Mailing Address
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Address Line | 625 N HARLEM AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1805
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Country | US
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Telephone | 708-848-5966
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Fax | 708-848-1257
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID WENGROW
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Credential |
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Telephone | 773-304-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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