King-Bruwaert House

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0002584 Issued in IL

Legal business name

KING-BRUWAERT HOUSE

Practice address

6101 S County Line Rd
Burr Ridge, IL 60527-8132

Phone

(630) 323-2250

Fax

(630) 655-8179

NPI assigned

Mar 19, 2014

Organization subpart

No

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

Authorized official

Name

Carl Baker

Title

Executive Director

Phone

(630) 230-9502

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1376960039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 S COUNTY LINE RD",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278132",
            "telephone_number": "630-323-2250",
            "fax_number": "630-655-8179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 S COUNTY LINE RD",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278132",
            "telephone_number": "630-323-2250",
            "fax_number": "630-655-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING-BRUWAERT HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-230-9502"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0002584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mouhammed Kelta, M.D
• Kerstin Blumhardt, PLLC
• Farisa Khan, P.T.
• Saleha Khan, M.D.
• Samah Khan, OTR/L
• Jerome M Klafta, MD
• Peter A Klock, MD
• Jessica Klonoski-Paganis, LCSW
• Carla Renee Knapke
• Orly Kohn, MD

• Skilled Nursing Facility in Burr Ridge, IL
• Providers in Burr Ridge, 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 Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.