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General NPI Number Information
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NPI Number | 1780789693
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Entity Type | Organization
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Legal Business Name | WILLOW OF MARENGO, INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 546 E GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-3346
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Country | US
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Telephone | 815-568-8322
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Fax | 815-568-0135
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Provider Business Mailing Address
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Address Line | 546 E GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-3346
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Country | US
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Telephone | 815-568-8322
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Fax | 815-568-0135
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Authorized Official
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Title or Position | COO
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Name | MR. JOSEPH BRANDMAN
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Credential |
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Telephone | 773-338-4400
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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 | 0041657
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License Number State | IL
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