MEDICARE: ELM CITY REHABILITATION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1104061662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELM CITY REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	1314 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1148
Country	:	US
Telephone Number	:	217-245-9504
Fax Number	:	217-245-2350

Provider Business Practice Location Address
First Line	:	575 BROOKLYN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2926
Country	:	US
Telephone Number	:	217-245-9504
Fax Number	:	217-245-2350

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. MARI A GOSNELL
Credential	:
Telephone Number	:	217-245-9504

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	11/15/2024

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