Provider Demographics
NPI:1942658315
Name:JOHN BERNADYN
Entity Type:Organization
Organization Name:JOHN BERNADYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNADYN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:312-914-0991
Mailing Address - Street 1:1407 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60436-2533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1407 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:IL
Practice Address - Zip Code:60436-2533
Practice Address - Country:US
Practice Address - Phone:312-914-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL044010067376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty