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General NPI Number Information
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NPI Number | 1649069600
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Entity Type | Organization
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Legal Business Name | EVERCARE OF BREESE LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1155 N 1ST ST
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City | BREESE
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State | IL
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Zip | 62230-1735
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Country | US
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Telephone | 618-526-4521
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60076-3407
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Country | US
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Telephone | 845-825-3197
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHMUEL WEINBERGER
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Credential |
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Telephone | 845-825-3197
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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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