Provider Demographics
NPI:1477984540
Name:RIVER NORTH OF BRADLEY HEALTH AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:RIVER NORTH OF BRADLEY HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:RIVER NORTH OF BRADLEY HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-521-2467
Mailing Address - Street 1:650 N KINZIE AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1227
Mailing Address - Country:US
Mailing Address - Phone:815-933-1666
Mailing Address - Fax:815-933-9886
Practice Address - Street 1:650 N KINZIE AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1227
Practice Address - Country:US
Practice Address - Phone:815-933-1666
Practice Address - Fax:815-933-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146112Medicare Oscar/Certification