Laureate Bourbonnais Operations LLC

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

LAUREATE BOURBONNAIS OPERATIONS LLC

Doing business as

Bourbonnais Terrace

Practice address

133 Mohawk Dr
Bourbonnais, IL 60914-1349

Phone

(815) 937-4790

Fax

(815) 937-0432

NPI assigned

Jul 12, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Shaun Ahmad

Title

Manager

Phone

(704) 426-8849

Specialties & licenses 1

Addresses

Other names 1

• Bourbonnais Terrace Doing business as

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1326690066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13024 BALLANTYNE CORPORATE PL STE 425",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774420",
            "telephone_number": "704-426-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 MOHAWK DR",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141349",
            "telephone_number": "815-937-4790",
            "fax_number": "815-937-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREATE BOURBONNAIS OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-426-8849",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bourbonnais Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Lareau, LSW
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• Alison Latham
• Robert J Latiker, LSW
• Laura Latocha, MA
• Laureate Kankakee Operations LLC
• Lavender Hope, PLLC
• LB Counseling and Consulting, LLC
• Joanne M Leahy-Auer, MD
• Jerry Joseph Lebeda Jr., DDS

• Mental Illness Intermediate Care Facility in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Mental Illness Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; 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.