MEDICARE: EDENBROOK ROCHESTER WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1013743731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDENBROOK ROCHESTER WEST LLC

Provider Business Mailing Address
First Line	:	8170 MCCORMICK BLVD STE 112
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2914
Country	:	US
Telephone Number	:	773-825-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HIGHWAY 52 N
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-7657
Country	:	US
Telephone Number	:	773-825-3336
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MAX STESEL
Credential	:
Telephone Number	:	773-825-3336

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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