Provider Demographics
NPI:1831281914
Name:WINDSOR PARK MANOR
Entity Type:Organization
Organization Name:WINDSOR PARK MANOR
Other - Org Name:COVENANT LIVING AT WINDSOR PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-4430
Mailing Address - Street 1:124 WINDSOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1986
Mailing Address - Country:US
Mailing Address - Phone:630-510-5500
Mailing Address - Fax:630-682-0946
Practice Address - Street 1:110 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1986
Practice Address - Country:US
Practice Address - Phone:630-510-5500
Practice Address - Fax:630-682-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0034652314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145606Medicare Oscar/Certification