Provider Demographics
NPI:1659568319
Name:BRAVO CARE OF NORTHBROOK INC
Entity Type:Organization
Organization Name:BRAVO CARE OF NORTHBROOK INC
Other - Org Name:ROSEWOOD CARE CENTER OF NORTHBROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-9070
Mailing Address - Street 1:11701 BORMAN DR STE 315
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1112
Practice Address - Country:US
Practice Address - Phone:847-562-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0Medicaid
IL145971Medicare Oscar/Certification