Provider Demographics
NPI:1558075630
Name:BARRY HEALTHCARE AND SENIOR LIVING LLC
Entity Type:Organization
Organization Name:BARRY HEALTHCARE AND SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-335-5326
Mailing Address - Street 1:8131 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3325
Mailing Address - Country:US
Mailing Address - Phone:773-945-1107
Mailing Address - Fax:
Practice Address - Street 1:1313 PRATT ST
Practice Address - Street 2:
Practice Address - City:BARRY
Practice Address - State:IL
Practice Address - Zip Code:62312-1365
Practice Address - Country:US
Practice Address - Phone:217-335-2326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility