Healthcare Provider Details

I. General information

NPI: 1245538149
Provider Name (Legal Business Name): BELLEVILLE BEHAVIORAL HEALTH & NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N 17TH ST
BELLEVILLE IL
62226-6552
US

IV. Provider business mailing address

4213 MAIN ST STE 310
SKOKIE IL
60076-2046
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-3323
  • Fax: 618-234-9477
Mailing address:
  • Phone: 708-426-2315
  • Fax: 708-236-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number23309
License Number StateIL

VIII. Authorized Official

Name: ALAN JASON IRNI
Title or Position: CFO
Credential:
Phone: 708-426-2315