Provider Demographics
NPI:1861490369
Name:SHERWIN MANOR NURSING CENTER, LLC
Entity Type:Organization
Organization Name:SHERWIN MANOR NURSING CENTER, LLC
Other - Org Name:SHERWIN MANOR NURSING CENTER, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-274-1700
Mailing Address - Street 1:7350 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2017
Mailing Address - Country:US
Mailing Address - Phone:773-274-1700
Mailing Address - Fax:773-274-0152
Practice Address - Street 1:7350 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2017
Practice Address - Country:US
Practice Address - Phone:773-274-1700
Practice Address - Fax:773-274-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046102313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid