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NPI Code Detail

MEDICARE: BRETHREN HOME

MEDICARE: BRETHREN HOME
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility1676853IL

General Provider Information

NPI Number : 1083609960
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRETHREN HOME
Provider Business Mailing Address
First Line : 414 S WESLEY AVE
Second Line :
City : MOUNT MORRIS
State : IL
Zip : 61054-1428
Country : US
Telephone Number : 815-734-4103
Fax Number : 815-734-7318
Provider Business Practice Location Address
First Line : 414 S WESLEY AVE
Second Line :
City : MOUNT MORRIS
State : IL
Zip : 61054-1428
Country : US
Telephone Number : 815-734-4103
Fax Number : 815-734-7318
Authorized Official
Title or Position : CEO
Name : MS. FEROL J. LABASH
Credential : NHA
Telephone Number : 815-734-4103
Provider Enumeration Date : 09/15/2005
Last Update Date : 03/12/2013

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Directions to “BRETHREN HOME ” Practice Location

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