HAVEN OF BRIDGEPORT, LLC
NPI 1992524060
Skilled Nursing Facility in Bridgeport, IL

Active since October 07, 2024CLIA 14D2339706 · Waiver
900 CORPORATION ST, BRIDGEPORT, IL 62417(618) 945-2091 Get Directions Write a Review

NPPES record last updated: March 7, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 7, 2025, Oct 7, 2024 (2 updates tracked since 2024).

About Haven Of Bridgeport, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAVEN OF BRIDGEPORT, LLC (NPI 1992524060) is a healthcare organization registered as a skilled nursing facility in Bridgeport, Illinois and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through March 4, 2028 and lists Levi Israel, Ceo, as its authorized official.

NPPES Registry Identity

NPI1992524060
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHAVEN OF BRIDGEPORT, LLC
Location Address900 CORPORATION STBridgeport, IL 62417-2206
Mailing Address2201 Main StEvanston, IL 60202-1519 · (847) 905-3220
Organization SubpartNo
Authorized OfficialLevi IsraelCeo · (847) 905-3000
Enumeration DateOctober 7, 2024
Last NPPES UpdateMarch 7, 20252 updates tracked since enumeration
NPPES CertifiedMarch 7, 2025
NPI 1992524060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

900 CORPORATION ST, Bridgeport, IL 62417

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2339706

Haven Of Bridgeport · Bridgeport, IL
Active · expires Mar 4, 2028
CLIA Number14D2339706
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateMarch 5, 2026
Certificate Expiration DateMarch 4, 2028
Laboratory DirectorNina Piper
Laboratory Phone(618) 945-2091
Laboratory LocationHaven Of Bridgeport900 E Corporation St, Bridgeport, IL 62417
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
900 CORPORATION ST
BRIDGEPORT, IL 62417
Durable Medical Equipment & Medical Supplies
900 CORPORATION ST
BRIDGEPORT, IL 62417

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1992524060, enumerated as an "organization" on October 07, 2024.

The provider is located at 900 CORPORATION ST BRIDGEPORT, IL 62417 and the phone number is (618) 945-2091.

Skilled Nursing Facility with taxonomy code 314000000X.