Walnut Grove Village

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0033506 Issued in IL

Legal business name

WALNUT GROVE VILLAGE

Practice address

4055 W Peterson Ave
Suite 101
Chicago, IL 60646-6182

Phone

(773) 202-0000

Fax

(773) 267-0111

NPI assigned

Jun 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Barak Baver

Title

Cfo

Phone

(773) 202-0000

Specialties & licenses 1

Addresses

Tax ID family

Coventry Village Healthcare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Coventry Village Healthcare

  • Skilled Nursing Facility
  • Chicago, IL
  • NPI 1477756724
  NPD tax ID

Locations

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497957997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 TWILIGHT DR",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503305",
            "telephone_number": "815-942-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 W PETERSON AVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466182",
            "telephone_number": "773-202-0000",
            "fax_number": "773-267-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT GROVE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAVER",
        "authorized_official_first_name": "BARAK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "773-202-0000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0033506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Pharmacy
• Walmart Pharmacy
• Kristen Walor, MS, CCC-SLP
• Walsh Behavioral Health Group PLLC
• Walsh Behavioral Health System L.L.C.
• Roserita Ryan Walsh James, LCSW, MSW, MA
• Amy Christine Walsh, PA-C

• Skilled Nursing Facility in Chicago, IL
• Providers in Chicago, 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 Aug 22, 2020; 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.