Provider Demographics
NPI:1235482381
Name:CLEARBROOK WEST
Entity Type:Organization
Organization Name:CLEARBROOK WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-870-7711
Mailing Address - Street 1:3980 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1313
Mailing Address - Country:US
Mailing Address - Phone:847-253-5155
Mailing Address - Fax:847-870-9970
Practice Address - Street 1:1835 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2410
Practice Address - Country:US
Practice Address - Phone:847-870-7711
Practice Address - Fax:847-870-9926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARBROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2067033315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities