Healthcare Provider Details

I. General information

NPI: 1871163030
Provider Name (Legal Business Name): BEACON CARE AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 N BEACON ST
CHICAGO IL
60640-5519
US

IV. Provider business mailing address

4538 N BEACON ST
CHICAGO IL
60640-5519
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NISANEL SILVERBERG
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 612-432-3701