Provider Demographics
NPI:1437423530
Name:BELLWOOD NURSING CENTER LLC
Entity Type:Organization
Organization Name:BELLWOOD NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-318-0043
Mailing Address - Street 1:2711 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1303
Mailing Address - Country:US
Mailing Address - Phone:708-547-3580
Mailing Address - Fax:
Practice Address - Street 1:105 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-1220
Practice Address - Country:US
Practice Address - Phone:708-547-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities