Healthcare Provider Details

I. General information

NPI: 1922152859
Provider Name (Legal Business Name): BRITISH HOME FOR RETIRED MEN AND WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 31ST ST
BROOKFIELD IL
60513-1000
US

IV. Provider business mailing address

8700 31ST ST
BROOKFIELD IL
60513-1000
US

V. Phone/Fax

Practice location:
  • Phone: 708-485-0135
  • Fax: 708-485-8844
Mailing address:
  • Phone: 708-485-0135
  • Fax: 708-485-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1676854
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN LARSON
Title or Position: CFO
Credential:
Phone: 708-485-0135