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NPI Code Detail

MEDICARE: WILLOWCREEK REHAB AND NURSING CENTER

MEDICARE: WILLOWCREEK REHAB AND NURSING CENTER
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility0041939IL
2314000000XSkilled Nursing Facility0041939IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10041939OTHERILFACILITY LICENSE NUMBER

General Provider Information

NPI Number : 1356348221
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOWCREEK REHAB AND NURSING CENTER
Provider Business Mailing Address
First Line : 1111 WESTGATE ST
Second Line : SUITE 110
City : OAK PARK
State : IL
Zip : 60301-1007
Country : US
Telephone Number : 312-994-2306
Fax Number :
Provider Business Practice Location Address
First Line : 40 N 64TH ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3808
Country : US
Telephone Number : 618-397-8400
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MR. STEPHEN P MILLER
Credential :
Telephone Number : 312-994-2306
Provider Enumeration Date : 07/06/2005
Last Update Date : 01/25/2008

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Directions to “WILLOWCREEK REHAB AND NURSING CENTER ” Practice Location

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