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NPI Code Detail

MEDICARE: BRAVO CARE OF ELGIN INC

MEDICARE: BRAVO CARE OF ELGIN INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)IL
2314000000XSkilled Nursing Facility1854225IL

General Provider Information

NPI Number : 1578750238
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAVO CARE OF ELGIN INC
Provider Business Mailing Address
First Line : 11701 BORMAN DR STE 315
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4194
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2355 ROYAL BLVD
Second Line :
City : ELGIN
State : IL
Zip : 60123-4716
Country : US
Telephone Number : 847-888-9585
Fax Number :
Authorized Official
Title or Position : AR DIRECTOR
Name : ALEKSANDRA SAVIC
Credential :
Telephone Number : 314-994-9070
Provider Enumeration Date : 09/26/2007
Last Update Date : 12/01/2016

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Directions to “BRAVO CARE OF ELGIN INC ” Practice Location

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