Provider Demographics
NPI:1427034651
Name:DEERBROOK CARE CENTER LP
Entity Type:Organization
Organization Name:DEERBROOK CARE CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-583-0100
Mailing Address - Street 1:306 N LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6698
Mailing Address - Country:US
Mailing Address - Phone:815-744-5560
Mailing Address - Fax:815-744-6914
Practice Address - Street 1:306 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6698
Practice Address - Country:US
Practice Address - Phone:815-744-5560
Practice Address - Fax:815-744-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL40741314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL40741OtherIDPH LICENSE NUMBER
IL6002463OtherIDPH FACILITY NUMBER
IL6002463OtherIDPH FACILITY NUMBER
145372Medicare Oscar/Certification