Provider Demographics
NPI:1952563207
Name:DUPAGE CONVALESCENT CENTER
Entity Type:Organization
Organization Name:DUPAGE CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ULMER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:630-784-4202
Mailing Address - Street 1:400 N COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3908
Mailing Address - Country:US
Mailing Address - Phone:630-784-4201
Mailing Address - Fax:630-784-4203
Practice Address - Street 1:400 N COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3908
Practice Address - Country:US
Practice Address - Phone:630-784-4201
Practice Address - Fax:630-784-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0008201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36600651002OtherROOM AND BOARD