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NPI Code Detail

MEDICARE: GOLDWATER CARE PEORIA HEIGHTS LLC

MEDICARE: GOLDWATER CARE PEORIA HEIGHTS 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 Facility

General Provider Information

NPI Number : 1811724511
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDWATER CARE PEORIA HEIGHTS LLC
Provider Business Mailing Address
First Line : 4655 W CHASE AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-1605
Country : US
Telephone Number : 847-262-3800
Fax Number :
Provider Business Practice Location Address
First Line : 5533 N GALENA RD
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-4447
Country : US
Telephone Number : 309-682-5428
Fax Number :
Authorized Official
Title or Position : VP OF REVENUE CYCLE MANAGEMENT
Name : JENNIFER SPECTOR
Credential :
Telephone Number : 847-262-3800
Provider Enumeration Date : 09/17/2024
Last Update Date : 09/25/2025

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Directions to “GOLDWATER CARE PEORIA HEIGHTS LLC ” Practice Location

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