Basic Information
| Provider Information | |||||||||
| NPI: | 1598137887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BREEZY MEADOWS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8153 LAWNDALE AVE | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600763321 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 416 S HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647301827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606796158 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 05/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | WEBSTER | ||||||||
| AuthorizedOfficialFirstName: | SHIMON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7739451000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.