Basic Information
| Provider Information | |||||||||
| NPI: | 1447249081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST ROCHELLE NURSING AND REHABILITATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 N CARON RD | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610689647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155624047 | ||||||||
| FaxNumber: | 8155626689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 N CARON RD | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610689647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155624047 | ||||||||
| FaxNumber: | 8155626689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ATKIN | ||||||||
| AuthorizedOfficialFirstName: | ELISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8474700000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LICENSE NH ADMIN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0044867 | IL | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.