Provider Demographics
NPI:1790572634
Name:WENTWORTH HOMES LLC
Entity type:Organization
Organization Name:WENTWORTH HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-419-5610
Mailing Address - Street 1:8153 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8153 LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3321
Practice Address - Country:US
Practice Address - Phone:773-419-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities