Healthcare Provider Details

I. General information

NPI: 1164248308
Provider Name (Legal Business Name): BERWYN RESPIRATORY & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S HARLEM AVE
BERWYN IL
60402-3219
US

IV. Provider business mailing address

5151 CHURCH ST
SKOKIE IL
60077-1123
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-4160
  • Fax:
Mailing address:
  • Phone: 847-933-9200
  • Fax: 847-933-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KIM BOULTON
Title or Position: CONTRACT COORDINATOR
Credential:
Phone: 847-786-9559