Basic Information
| Provider Information | |||||||||
| NPI: | 1821087008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WATERFORD NURSING & REHABILITATION CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7445 N SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606261818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733383300 | ||||||||
| FaxNumber: | 7733385868 | ||||||||
| Practice Location | |||||||||
| Address1: | 7445 N SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606261818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733383300 | ||||||||
| FaxNumber: | 7733385868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | HERLIHY | ||||||||
| AuthorizedOfficialFirstName: | SYLVIA | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7733383300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0038612 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.