1336221456 NPI number — RANCHO MANOR HEALTHCARE AND REHAB CENTER LLC

Table of content: (NPI 1336221456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336221456 NPI number — RANCHO MANOR HEALTHCARE AND REHAB CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANCHO MANOR HEALTHCARE AND REHAB CENTER LLC
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:
Provider Other Organization Name Type Code:
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:
1336221456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7434 SKOKIE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-982-2300
Provider Business Mailing Address Fax Number:
847-982-2304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 RANCHO LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63031-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-839-2150
Provider Business Practice Location Address Fax Number:
314-839-8736
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZUCKERMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
847-982-2300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com