Healthcare Provider Details

I. General information

NPI: 1144499310
Provider Name (Legal Business Name): BERWYN REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S HARLEM AVE
BERWYN IL
60402-3219
US

IV. Provider business mailing address

3601 S HARLEM AVE
BERWYN IL
60402-3219
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-4160
  • Fax: 708-749-7696
Mailing address:
  • Phone: 708-749-4160
  • Fax: 708-749-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046292
License Number StateIL

VIII. Authorized Official

Name: MARK STEINBERG
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 847-905-3000