Provider Type Icon

BOURBONNAIS TERRACE OPERATOR LLC NPI 1760579163


NPI Information

NPI: 1760579163
Provider Name: BOURBONNAIS TERRACE OPERATOR LLC

Former Legal Business Name: BOURBONNAIS TERRACE

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization

CLIA Number: 14D0429358

Address:
133 MOHAWK DR
BOURBONNAIS, IL
ZIP 60914
Phone: (815) 937-4790
Get Directions

BOURBONNAIS TERRACE OPERATOR LLC is a nursing facility intermediate care facility in Bourbonnais, IL. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. BOURBONNAIS TERRACE OPERATOR LLC NPI is 1760579163. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Bourbonnais Terrace.

The provider's business location address is:

133 MOHAWK DR
BOURBONNAIS, IL
ZIP 60914-349
Phone: (815) 937-4790
Fax: (815) 937-0432

The provider's authorized official is Avrum Weinfeld .
The authorized official title is Cfo and has the following contact phone number (847) 674-5795.

The CLIA number assigned to this NPI record is 14D0429358 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/6/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility0021550ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10021550MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.