Healthcare Provider Details

I. General information

NPI: 1023748597
Provider Name (Legal Business Name): BRIA OF WOODRIVER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 10/16/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E EDWARDSVILLE RD
WOOD RIVER IL
62095-1646
US

IV. Provider business mailing address

5151 CHURCH ST
SKOKIE IL
60077-1123
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-4111
  • Fax: 618-259-5791
Mailing address:
  • Phone: 847-933-9200
  • Fax: 847-933-9765

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: AVRUM WEINFELD
Title or Position: CFO
Credential:
Phone: 847-933-9200