Organization
PHWD, LLC
Active
Other names
All Faith Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARALEE RUNGE (OFFICE MANAGER)
(847) 329-4100
Entity
Organization
Contact information
Practice address
3500 S GILES AVE, CHICAGO, IL 60653-1106
(312) 326-2000
(312) 326-5753
Mailing address
7444 LONG AVE, SKOKIE, IL 60077-3214
(847) 329-4100
(847) 329-4900
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0020404
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-5856
MEDICARE PROVIDER A
—
Enumeration date
11/28/2007
Last updated
01/15/2009
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