Healthcare Provider Details

I. General information

NPI: 1528149382
Provider Name (Legal Business Name): BELMONT NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 W BELMONT AVE
CHICAGO IL
60657-2025
US

IV. Provider business mailing address

1936 W BELMONT AVE
CHICAGO IL
60657-2025
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-7176
  • Fax: 773-525-8929
Mailing address:
  • Phone: 773-525-7176
  • Fax: 773-525-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number0024968
License Number StateIL

VIII. Authorized Official

Name: EILEEN CONWAY
Title or Position: PRESIDENT
Credential:
Phone: 773-525-7176