1700850526 NPI number — CASEYVILLE NURSING AND REHAB. 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 1700850526 NPI number — CASEYVILLE NURSING AND REHAB. CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASEYVILLE NURSING AND REHAB. 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:
CASEYVILLE NURSING & REHABILITATION CENTER
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:
1700850526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2023
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:
601 W LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASEYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62232-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-345-3072
Provider Business Practice Location Address Fax Number:
618-345-3170
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0039644 , 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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