Basic Information
| Provider Information | |||||||||
| NPI: | 1518474931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIR OAKS NURSING AND REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD STE 112 | ||||||||
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| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738253336 | ||||||||
| FaxNumber: | 8474236991 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SHADY LANE DR | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564823093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186311391 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2018 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7738253336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.