Organization
BOURBONNAIS TERRACE OPERATOR LLC
Active
Other names
bourbonnais terrace
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AVRUM WEINFELD (CFO)
(847) 674-5795
Entity
Organization
Contact information
Practice address
133 MOHAWK DR, BOURBONNAIS, IL 60914-1349
(815) 937-4790
(815) 937-0432
Mailing address
6865 N LINCOLN AVE, LINCOLNWOOD, IL 60712-4611
(847) 674-5795
(847) 674-5794
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0021550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021550
—
IL
Enumeration date
10/06/2006
Last updated
08/22/2020
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