Basic Information
| Provider Information | |||||||||
| NPI: | 1952398414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BELLEVILLE HEALTHCARE & REHAB CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE LINCOLN HOME, INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600771123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479339200 | ||||||||
| FaxNumber: | 8479339200 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 N 27TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622266621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182356600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEINFELD | ||||||||
| AuthorizedOfficialFirstName: | AVRUM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8476745795 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 6005474 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.