Provider Demographics
NPI:1710002035
Name:WHEATON CARE CENTER
Entity Type:Organization
Organization Name:WHEATON CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-905-4000
Mailing Address - Street 1:1325 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4760
Mailing Address - Country:US
Mailing Address - Phone:630-668-2500
Mailing Address - Fax:630-668-0232
Practice Address - Street 1:1325 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4760
Practice Address - Country:US
Practice Address - Phone:630-668-2500
Practice Address - Fax:630-668-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039115313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1066OtherBLUE CROSS BLUE SHIELD
IL1066OtherBLUE CROSS BLUE SHIELD
IL1066OtherBLUE CROSS BLUE SHIELD