Provider Demographics
NPI:1275989683
Name:SENIOR SUITES AT WOODSIDE VILLAGE, LLC
Entity Type:Organization
Organization Name:SENIOR SUITES AT WOODSIDE VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:STESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-942-7575
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-763-1111
Mailing Address - Fax:847-423-6991
Practice Address - Street 1:19455 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2000
Practice Address - Country:US
Practice Address - Phone:440-359-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility