Provider Demographics
NPI:1841536992
Name:CHAMPAIGN URBANA NURSING AND REHAB LP
Entity type:Organization
Organization Name:CHAMPAIGN URBANA NURSING AND REHAB LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-575-2222
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-674-8200
Mailing Address - Fax:814-674-4133
Practice Address - Street 1:302 BURWASH AVE
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9572
Practice Address - Country:US
Practice Address - Phone:217-402-9700
Practice Address - Fax:217-402-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2075539314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0050062Medicaid
IL145439Medicare Oscar/Certification