Provider Demographics
NPI:1033291216
Name:WEST RIDGE REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:WEST RIDGE REHABILITATION CENTER, LLC
Other - Org Name:NORTHWEST HOME FOR THE AGED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:W
Authorized Official - Last Name:FEIGENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-973-1900
Mailing Address - Street 1:6300 N. CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1702
Mailing Address - Country:US
Mailing Address - Phone:773-973-1900
Mailing Address - Fax:773-973-7327
Practice Address - Street 1:6300 N. CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1702
Practice Address - Country:US
Practice Address - Phone:773-973-1900
Practice Address - Fax:773-973-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0019091314000000X
IL0049817314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid
IL=========0001Medicaid