MEDICARE: RESTHAVE HOME OF WHITESIDE COUNTY ILLINOIS

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
1	314000000X	Skilled Nursing Facility	0005785	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	IL6007884	OTHER	IL	FACILITY USER NAME

General Provider Information

NPI Number	:	1417943812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTHAVE HOME OF WHITESIDE COUNTY ILLINOIS

Provider Business Mailing Address
First Line	:	408 MAPLE AVE
Second Line	:
City	:	MORRISON
State	:	IL
Zip	:	61270-2936
Country	:	US
Telephone Number	:	815-772-4021
Fax Number	:	815-772-4583

Provider Business Practice Location Address
First Line	:	408 MAPLE AVE
Second Line	:
City	:	MORRISON
State	:	IL
Zip	:	61270-2936
Country	:	US
Telephone Number	:	815-772-4021
Fax Number	:	815-772-4583

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. TAMI SUE TEGELER
Credential	:
Telephone Number	:	815-772-4021

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	06/27/2016

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