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NPI Code Detail

MEDICARE: VILLA AT WINDSOR PARK NURSING AND LIVING CENTER, LLC

MEDICARE: VILLA AT WINDSOR PARK NURSING AND LIVING CENTER, 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
1314000000XSkilled Nursing FacilityLICENSE APPLIED FOR

General Provider Information

NPI Number : 1376863019
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLA AT WINDSOR PARK NURSING AND LIVING CENTER, LLC
Provider Business Mailing Address
First Line : 7040 N RIDGEWAY AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-2620
Country : US
Telephone Number : 847-679-9797
Fax Number : 847-679-1126
Provider Business Practice Location Address
First Line : 2649 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-356-9300
Fax Number : 773-356-9384
Authorized Official
Title or Position : MANAGER
Name : MENACHEM BERGER
Credential :
Telephone Number : 847-679-9797
Provider Enumeration Date : 06/04/2010
Last Update Date : 04/27/2021

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