Provider Demographics
NPI:1063006419
Name:BROOKSTONE ESTATES OF TUSCOLA
Entity Type:Organization
Organization Name:BROOKSTONE ESTATES OF TUSCOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:E
Authorized Official - Last Name:FINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-837-0704
Mailing Address - Street 1:30 S WACKER DR STE 1300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-7466
Mailing Address - Country:US
Mailing Address - Phone:312-837-0701
Mailing Address - Fax:
Practice Address - Street 1:1106 E NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-7836
Practice Address - Country:US
Practice Address - Phone:217-253-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELL PATH TENANT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility