Healthcare Provider Details

I. General information

NPI: 1497089973
Provider Name (Legal Business Name): BERKELEY NURSING AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 NORTH AVE
OAK PARK IL
60302-1008
US

IV. Provider business mailing address

6909 NORTH AVE
OAK PARK IL
60302-1008
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-1112
  • Fax: 708-524-4818
Mailing address:
  • Phone: 708-386-1112
  • Fax: 708-524-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1945376
License Number StateIL

VIII. Authorized Official

Name: SARRAH JOSHUA
Title or Position: CONTROLLER
Credential:
Phone: 708-386-1112