Provider Demographics
NPI:1063237030
Name:NELP-WYNDEMERE OPERATOR LLC
Entity type:Organization
Organization Name:NELP-WYNDEMERE OPERATOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSAHW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-448-0273
Mailing Address - Street 1:2180 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4580
Mailing Address - Country:US
Mailing Address - Phone:630-665-4330
Mailing Address - Fax:
Practice Address - Street 1:2180 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4599
Practice Address - Country:US
Practice Address - Phone:630-665-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility