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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
1261QP2000XPhysical Therapy Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12038043OTHERILLICENSE NUMBER

General Provider Information

NPI Number : 1154663946
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 : CHIEF EXECUTIVE OFFICER
Name : FEROL J LABASH
Credential : NHA
Telephone Number : 815-734-4103
Provider Enumeration Date : 03/20/2013
Last Update Date : 04/05/2013

Similar Medicare Providers

1083609960 — BRETHREN HOME
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax: 815-734-7318
1548412976 — BRETHREN HOME
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax: 815-734-7318
1952705188 — MRS. WHITNEY ANN CERVANTEZ M.S. SLP
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax:
1578010377 — KRISTEN GILBERT COTA
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax:
1447898671 — KRISTIN CHARLESTON PTA
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax:
1962128538 — ALLURE OF PINECREST LLC
Practice Location Address:
414 S WESLEY AVE
MOUNT MORRIS, IL
61054-1428
Practice Phone: 815-734-4103
Practice Fax: 815-743-7318

Directions to “BRETHREN HOME ” Practice Location

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