Provider Demographics
NPI:1891454872
Name:BRIA OF MASCOUTAH LLC
Entity Type:Organization
Organization Name:BRIA OF MASCOUTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-933-9200
Mailing Address - Street 1:5151 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1123
Mailing Address - Country:US
Mailing Address - Phone:847-933-9200
Mailing Address - Fax:847-933-9765
Practice Address - Street 1:901 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-1017
Practice Address - Country:US
Practice Address - Phone:618-566-2183
Practice Address - Fax:847-933-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility