MEDICARE: PHWD, 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	0020404	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14-5856	OTHER		MEDICARE PROVIDER A

General Provider Information

NPI Number	:	1154503597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHWD, LLC

Provider Business Mailing Address
First Line	:	7444 LONG AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3214
Country	:	US
Telephone Number	:	847-329-4100
Fax Number	:	847-329-4900

Provider Business Practice Location Address
First Line	:	3500 S GILES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1106
Country	:	US
Telephone Number	:	312-326-2000
Fax Number	:	312-326-5753

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MARALEE RUNGE
Credential	:
Telephone Number	:	847-329-4100

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	01/15/2009

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