Provider Demographics
NPI:1649395963
Name:WASHINGTON HEIGHTS CARE CENTER, LLC
Entity Type:Organization
Organization Name:WASHINGTON HEIGHTS CARE CENTER, LLC
Other - Org Name:WASHINGTON HEIGHTS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-905-3000
Mailing Address - Street 1:1010 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1522
Mailing Address - Country:US
Mailing Address - Phone:773-298-1177
Mailing Address - Fax:773-298-1047
Practice Address - Street 1:1010 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1522
Practice Address - Country:US
Practice Address - Phone:773-298-1177
Practice Address - Fax:773-298-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0042044314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1128OtherBLUE CROSS BLUE SHIELD
IL364100431001Medicaid
IL14-5914Medicare ID - Type Unspecified