Basic Information
| Provider Information | |||||||||
| NPI: | 1700850526 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASEYVILLE NURSING AND REHAB. CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CASEYVILLE NURSING & REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7434 SKOKIE BLVD | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600773341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479822300 | ||||||||
| FaxNumber: | 8479822304 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | CASEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622321306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183453072 | ||||||||
| FaxNumber: | 6183453170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | HERMAN | ||||||||
| AuthorizedOfficialFirstName: | MOE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 8479822300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0039644 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.