Provider Demographics
NPI:1982153425
Name:MARKLUND WASMOND HOME
Entity Type:Organization
Organization Name:MARKLUND WASMOND HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-593-5476
Mailing Address - Street 1:1S450 WYATT DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4921
Mailing Address - Country:US
Mailing Address - Phone:630-593-5500
Mailing Address - Fax:
Practice Address - Street 1:1435 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-9218
Practice Address - Country:US
Practice Address - Phone:847-741-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARKLUND CHILDREN'S HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric