Organization
17400 S KEDZIE AVE LLC
Active
Other names
Waterford Estates
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY PETERSON (VICE PRESIDENT)
(813) 415-7589
Entity
Organization
Contact information
Practice address
17400 KEDZIE AVE, HAZEL CREST, IL 60429-1600
(618) 780-3256
Mailing address
17400 KEDZIE AVE, HAZEL CREST, IL 60429-1600
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Enumeration date
03/07/2024
Last updated
05/17/2024
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