Provider Demographics
NPI:1861122335
Name:BRIA OF GODFREY LP
Entity type:Organization
Organization Name:BRIA OF GODFREY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-933-9200
Mailing Address - Street 1:5151 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1123
Mailing Address - Country:US
Mailing Address - Phone:847-933-9200
Mailing Address - Fax:847-933-9765
Practice Address - Street 1:1623 W DELMAR AVE
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1317
Practice Address - Country:US
Practice Address - Phone:618-466-0443
Practice Address - Fax:618-466-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility