Organization
WENTWORTH REHABILITATION AND HEALTH CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN AVELINO (ACCOUNTS RECIEVABLE MANAGER)
(773) 724-6376
Entity
Organization
Contact information
Practice address
201 W 69TH ST, CHICAGO, IL 60621-3719
(773) 487-1200
(773) 487-4782
Mailing address
4200 W PETERSON AVE, SUITE 140, CHICAGO, IL 60646-6074
(773) 286-6622
(773) 286-2150
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0026435
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1005
BLUE CROSS
IL
Enumeration date
10/06/2005
Last updated
05/10/2019
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