Basic Information
| Provider Information | |||||||||
| NPI: | 1215934104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANKFORT HEALTHCARE & REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 NW PLAZA DR STE 712 | ||||||||
| Address2: | |||||||||
| City: | SAINT ANN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630742222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143172003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 E SAINT LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628961751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189323236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3129942306 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0046268 | IL | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0046268 | 01 | IL | FACILITY LICENSE NUMBER | OTHER |