MEDICARE: MOMENCE MEADOWS NURSING AND REHABILITATION 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
1	314000000X	Skilled Nursing Facility	0048033	IL

General Provider Information

NPI Number	:	1710138961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENCE MEADOWS NURSING AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	500 S WALNUT ST
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954-1814
Country	:	US
Telephone Number	:	815-472-2423
Fax Number	:	815-472-6212

Provider Business Practice Location Address
First Line	:	500 S WALNUT ST
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954-1814
Country	:	US
Telephone Number	:	815-472-2423
Fax Number	:	815-472-6212

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MELISSA DYER
Credential	:
Telephone Number	:	815-472-2423

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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