MEDICARE: NORTH CHURCH NURSING & REHAB, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1528600434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CHURCH NURSING & REHAB, LLC

Provider Business Mailing Address
First Line	:	4655 W CHASE AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1605
Country	:	US
Telephone Number	:	847-262-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 N CHURCH ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1301
Country	:	US
Telephone Number	:	217-245-4174
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YOSEF MEYSTEL
Credential	:
Telephone Number	:	847-262-3800

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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