Provider Demographics
NPI:1497089973
Name:BERKELEY NURSING AND REHAB
Entity Type:Organization
Organization Name:BERKELEY NURSING AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-386-1112
Mailing Address - Street 1:6909 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1008
Mailing Address - Country:US
Mailing Address - Phone:708-386-1112
Mailing Address - Fax:708-524-4818
Practice Address - Street 1:6909 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1008
Practice Address - Country:US
Practice Address - Phone:708-386-1112
Practice Address - Fax:708-524-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1945376314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146013Medicare Oscar/Certification