Provider Demographics
NPI:1598789059
Name:ARTHUR MERKLE-CLARA KNIPPRATH NURSING HOME
Entity Type:Organization
Organization Name:ARTHUR MERKLE-CLARA KNIPPRATH NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRAEKELEER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:815-694-2306
Mailing Address - Street 1:1190 E 2900 N RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:IL
Mailing Address - Zip Code:60927-7103
Mailing Address - Country:US
Mailing Address - Phone:815-694-2306
Mailing Address - Fax:815-394-2818
Practice Address - Street 1:1190 E 2900 N RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:IL
Practice Address - Zip Code:60927-7103
Practice Address - Country:US
Practice Address - Phone:815-694-2306
Practice Address - Fax:815-694-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0021832251J00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
146085Medicare ID - Type Unspecified