Healthcare Provider Details

I. General information

NPI: 1659568319
Provider Name (Legal Business Name): BRAVO CARE OF NORTHBROOK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 LAKE COOK RD
NORTHBROOK IL
60062-1112
US

IV. Provider business mailing address

11701 BORMAN DR STE 315
SAINT LOUIS MO
63146-4194
US

V. Phone/Fax

Practice location:
  • Phone: 847-562-1770
  • 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: ALEKSANDRA SAVIC
Title or Position: AR DIRECTOR
Credential:
Phone: 314-994-9070