Provider Demographics
NPI:1508182544
Name:WILLMINGTON NURSING &REHABILITATION CENTER,L.L.C.
Entity Type:Organization
Organization Name:WILLMINGTON NURSING &REHABILITATION CENTER,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-5795
Mailing Address - Street 1:6865 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4611
Mailing Address - Country:US
Mailing Address - Phone:847-674-5795
Mailing Address - Fax:847-674-5794
Practice Address - Street 1:555 W KAHLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1527
Practice Address - Country:US
Practice Address - Phone:815-476-2200
Practice Address - Fax:847-679-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1940522314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid