Kankakee Terrace Operator LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0022897 Issued in IL

Legal business name

KANKAKEE TERRACE OPERATOR LLC

Practice address

100 Belle Aire Ave
Bourbonnais, IL 60914-2006

Phone

(815) 939-0910

Fax

(815) 939-0973

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Avrum Weinfeld

Title

Cfo

Phone

(847) 674-5795

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• kankakee terrace Former legal business name

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326128554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6865 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607124611",
            "telephone_number": "847-674-5795",
            "fax_number": "847-674-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BELLE AIRE AVE",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142006",
            "telephone_number": "815-939-0910",
            "fax_number": "815-939-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANKAKEE TERRACE OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEINFELD",
        "authorized_official_first_name": "AVRUM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-674-5795",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0022897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362883311001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "kankakee terrace",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Snigdha Kalidindi
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• Brandi Kaye Kaner
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• Matthew Kaplan, DO
• Craig T Karvala, D.C.
• Katelyn Dircks
• Katelyn E. Dircks, LCSW, PLLC

• Nursing Facility/Intermediate Care Facility in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.