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NPI Code Detail

MEDICARE: MANOR CARE OF HOMEWOOD IL, LLC

MEDICARE: MANOR CARE OF HOMEWOOD IL, 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
1261QR0400XRehabilitation Clinic/Center
2314000000XSkilled Nursing Facility0036202IL

General Provider Information

NPI Number : 1063459782
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANOR CARE OF HOMEWOOD IL, LLC
Provider Business Mailing Address
First Line : 333 N SUMMIT ST
Second Line :
City : TOLEDO
State : OH
Zip : 43604-2615
Country : US
Telephone Number : 419-252-5500
Fax Number : 877-385-9446
Provider Business Practice Location Address
First Line : 940 MAPLE RD
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-2061
Country : US
Telephone Number : 708-799-0244
Fax Number : 708-799-1505
Authorized Official
Title or Position : DIRECTOR
Name : MR. MARTIN D ALLEN
Credential :
Telephone Number : 419-252-5734
Provider Enumeration Date : 06/01/2006
Last Update Date : 02/28/2023

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Directions to “MANOR CARE OF HOMEWOOD IL, LLC ” Practice Location

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