Provider Demographics
NPI:1245538149
Name:BELLEVILLE BEHAVIORAL HEALTH & NURSING CENTER LLC
Entity type:Organization
Organization Name:BELLEVILLE BEHAVIORAL HEALTH & NURSING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:IRNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-426-2315
Mailing Address - Street 1:4213 MAIN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2046
Mailing Address - Country:US
Mailing Address - Phone:708-426-2315
Mailing Address - Fax:708-236-0001
Practice Address - Street 1:727 N 17TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6552
Practice Address - Country:US
Practice Address - Phone:618-234-3323
Practice Address - Fax:618-234-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23309314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145290Medicare Oscar/Certification