1912206731 NPI number — WAY-FAIR NURSING AND REHABILITATION CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912206731 NPI number — WAY-FAIR NURSING AND REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAY-FAIR NURSING AND REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912206731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7383 N LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-440-2233
Provider Business Mailing Address Fax Number:
847-430-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 NORTHWEST 11TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-842-3036
Provider Business Practice Location Address Fax Number:
618-842-3258
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ARYEH
Authorized Official First Name:
MOSHE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
847-440-2233

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2025481 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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