Berwyn Respiratory & Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BERWYN RESPIRATORY & REHABILITATION CENTER LLC

Practice address

3601 S Harlem Ave
Berwyn, IL 60402-3219

Phone

(708) 749-4160

NPI assigned

Dec 3, 2024

Last updated

Dec 5, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Boulton

Title

Contract Coordinator

Phone

(847) 786-9559

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1164248308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 CHURCH ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771123",
            "telephone_number": "847-933-9200",
            "fax_number": "847-933-9765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 S HARLEM AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023219",
            "telephone_number": "708-749-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERWYN RESPIRATORY & REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "BOULTON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CONTRACT COORDINATOR",
        "authorized_official_telephone_number": "847-786-9559"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.