1568467306 NPI number — MERCY REHAB AND CARE CENTER, INC.

Table of content: (NPI 1568467306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568467306 NPI number — MERCY REHAB AND CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY REHAB AND CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROSEWOOD CARE CENTER OF SWANSEA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568467306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11861 WESTLINE INDUSTRIAL DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-548-2250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ROSEWOOD VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-236-1391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VANDER MATEN
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-548-2250

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0032680 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 1303590001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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