Basic Information
| Provider Information | |||||||||
| NPI: | 1104160845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVERSHORES HEALTHCARE AND REHABILITATION CENTRE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RIVERSHORES HEALTHCARE AND REHABILITATION CENTRE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 578 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MARSEILLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613411814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157955121 | ||||||||
| FaxNumber: | 8157956213 | ||||||||
| Practice Location | |||||||||
| Address1: | 578 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MARSEILLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613411814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157955121 | ||||||||
| FaxNumber: | 8157956213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 08/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ACCOUNTS RECEIVABLES | ||||||||
| AuthorizedOfficialTelephone: | 7738979231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.