Basic Information
| Provider Information | |||||||||
| NPI: | 1639814197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLOUGHBY AL OPERATIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738253336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35300 KAISER CT | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440946633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402698600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2022 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | STESEL | ||||||||
| AuthorizedOfficialFirstName: | MAXIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7738253336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.