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General NPI Number Information
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NPI Number | 1497485965
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Entity Type | Organization
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Legal Business Name | BRIA OF ALTON LP
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3523 WICKENHAUSER AVE
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City | ALTON
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State | IL
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Zip | 62002-2118
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Country | US
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Telephone | 618-465-8887
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Fax | 618-465-1811
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Provider Business Mailing Address
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Address Line | 5151 CHURCH ST
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City | SKOKIE
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State | IL
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Zip | 60077-1123
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Country | US
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Telephone | 847-933-9200
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Fax | 847-933-9765
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Authorized Official
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Title or Position | CFO
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Name | AVRUN WEINFELD
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Credential |
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Telephone | 847-933-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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