Basic Information
| Provider Information | |||||||||
| NPI: | 1083604128 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMINGTON NURSING & REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 N SAINT LOUIS AVE | ||||||||
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| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607123726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476779823 | ||||||||
| FaxNumber: | 8476779837 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 HALE ST | ||||||||
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| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373821621 | ||||||||
| FaxNumber: | 9373831215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FEIGENBAUM | ||||||||
| AuthorizedOfficialFirstName: | LEO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8476779823 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1407-NH | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2408871 | 05 | OH | MEDICAID |