1447249081 NPI number — EAST ROCHELLE NURSING AND REHABILITATION CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447249081 NPI number — EAST ROCHELLE NURSING AND REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ROCHELLE NURSING AND REHABILITATION CENTER
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:
1447249081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 N CARON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHELLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61068-9647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-562-4047
Provider Business Mailing Address Fax Number:
815-562-6689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 N CARON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHELLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61068-9647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-562-4047
Provider Business Practice Location Address Fax Number:
815-562-6689
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ATKIN
Authorized Official First Name:
ELISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
847-470-0000

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  0044867 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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