Basic Information
| Provider Information | |||||||||
| NPI: | 1245538149 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BELLEVILLE BEHAVIORAL HEALTH & NURSING CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRITY HC OF BELLEVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4213 MAIN ST STE 310 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084262315 | ||||||||
| FaxNumber: | 7082360001 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 N 17TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622266552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182343323 | ||||||||
| FaxNumber: | 6182349477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRNI | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | JASON | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7084262315 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 23309 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.