MEDICARE: DOLTON HEALTHCARE & REHABILITATION CENTRE,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	314000000X	Skilled Nursing Facility		IL

General Provider Information

NPI Number	:	1982690350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLTON HEALTHCARE & REHABILITATION CENTRE,LLC

Provider Business Mailing Address
First Line	:	14325 BLACKSTONE AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1323
Country	:	US
Telephone Number	:	708-849-5000
Fax Number	:	708-849-3190

Provider Business Practice Location Address
First Line	:	14325 BLACKSTONE AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1323
Country	:	US
Telephone Number	:	708-849-5000
Fax Number	:	708-849-3190

Authorized Official
Title or Position	:	V.P. FINANCE
Name	:	MISS CHRISTOPHER VICERE
Credential	:
Telephone Number	:	773-604-4416

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/22/2020

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