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General NPI Number Information
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NPI Number | 1790374510
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Entity Type | Organization
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Legal Business Name | HARBOR HOUSE OF WHEELING IV, LLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 760 MCHENRY RD
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City | WHEELING
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State | IL
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Zip | 60090-3861
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Country | US
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Telephone | 847-465-1100
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Fax | 847-465-0146
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Provider Business Mailing Address
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Address Line | 760 MCHENRY RD
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City | WHEELING
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State | IL
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Zip | 60090-3861
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Country | US
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Telephone | 847-465-1100
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Fax | 847-465-0146
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BENJAMIN ISRAEL
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Credential |
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Telephone | 847-440-2660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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