Provider Demographics
NPI:1649069600
Name:EVERCARE OF BREESE LLC
Entity type:Organization
Organization Name:EVERCARE OF BREESE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-825-3197
Mailing Address - Street 1:3700 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3407
Mailing Address - Country:US
Mailing Address - Phone:845-825-3197
Mailing Address - Fax:
Practice Address - Street 1:1155 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1735
Practice Address - Country:US
Practice Address - Phone:618-526-4521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility