Basic Information
| Provider Information | |||||||||
| NPI: | 1275989683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR SUITES AT WOODSIDE VILLAGE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477631111 | ||||||||
| FaxNumber: | 8474236991 | ||||||||
| Practice Location | |||||||||
| Address1: | 19455 ROCKSIDE RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441462000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403596139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | STESEL | ||||||||
| AuthorizedOfficialFirstName: | MAX | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8479427575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.