Healthcare Provider Details

I. General information

NPI: 1972501898
Provider Name (Legal Business Name): BELHAVEN NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 S OAKLEY AVE
CHICAGO IL
60643-4196
US

IV. Provider business mailing address

11401 S OAKLEY AVE
CHICAGO IL
60643-4196
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-6311
  • Fax: 773-233-9304
Mailing address:
  • Phone: 773-233-6311
  • Fax: 773-233-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0048215
License Number StateIL

VIII. Authorized Official

Name: MRS. MARY G RICHARDSON
Title or Position: CONTROLLER
Credential:
Phone: 773-233-6311