Provider Demographics
NPI:1487927968
Name:WINDSOR PARK NURSING
Entity type:Organization
Organization Name:WINDSOR PARK NURSING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ONUWA
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:EJECHI
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:1773-356-9300
Mailing Address - Street 1:2649 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3835
Mailing Address - Country:US
Mailing Address - Phone:773-356-9300
Mailing Address - Fax:
Practice Address - Street 1:2649 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3835
Practice Address - Country:US
Practice Address - Phone:773-356-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003496314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility