Provider Demographics
NPI:1164405106
Name:WRHC & RC INC.
Entity Type:Organization
Organization Name:WRHC & RC INC.
Other - Org Name:WOODSTOCK RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-983-4860
Mailing Address - Street 1:309 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098
Mailing Address - Country:US
Mailing Address - Phone:815-338-1700
Mailing Address - Fax:815-338-1765
Practice Address - Street 1:309 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:815-338-1700
Practice Address - Fax:815-338-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038653314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL145222Medicare Oscar/Certification