Manor Care of Homewood Il, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0036202 Issued in IL

Legal business name

MANOR CARE OF HOMEWOOD IL, LLC

Practice address

940 Maple Rd
Homewood, IL 60430-2061

Phone

(708) 799-0244

Fax

(708) 799-1505

NPI assigned

Jun 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 2

Addresses

Other names 1

• ProMedica Skilled Nursing and Rehabilitation (Homewood) Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1063459782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 MAPLE RD",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302061",
            "telephone_number": "708-799-0244",
            "fax_number": "708-799-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE OF HOMEWOOD IL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0036202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N St 6th #900a",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ProMedica Skilled Nursing and Rehabilitation (Homewood)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Skilled Nursing and Rehabilitation (Homewood)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Magas, PHARMD
• Debra Majewski, LCPC
• Nour Malak, D.N.
• Elizabeth Ryann Maloney
• Maxine Ann Mancino, LCPC
• Joe Roberson Mardis, LCPC
• Marek Walczyk MD,SC
• Rashel Marrero, LSW
• Mars Optical Group Inc
• Frances Mathews

• Skilled Nursing Facility in Homewood, IL
• Providers in Homewood, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.