=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760300222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERKELEY HEALTH & REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2026
-----------------------------------------------------
Last Update Date | 07/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6909 NORTH AVE
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-386-1112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6500 N HAMLIN AVE STE 1
-----------------------------------------------------
City | LINCOLNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60712-3904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-679-7620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | JACOB MERMELSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-679-7484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------