MEDICARE: WOOD GLEN PAVILION, 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	0043935	IL

General Provider Information

NPI Number	:	1508074667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOD GLEN PAVILION, LLC

Provider Business Mailing Address
First Line	:	201 W NORTH AVE
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-6224
Country	:	US
Telephone Number	:	630-876-8100
Fax Number	:

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

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BEN KLEIN
Credential	:
Telephone Number	:	847-329-4100

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	08/22/2020

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