Healthcare Provider Details

I. General information

NPI: 1457659740
Provider Name (Legal Business Name): ALTON REHABILITATION AND NURSING CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 WICKENHAUSER AVE
ALTON IL
62002-2118
US

IV. Provider business mailing address

3523 WICKENHAUSER
ALTON IL
62002-2118
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-8887
  • Fax: 618-465-1811
Mailing address:
  • Phone: 618-465-8887
  • Fax: 618-465-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0051334
License Number StateIL

VIII. Authorized Official

Name: ALAN JASON IRNI
Title or Position: CFO
Credential:
Phone: 708-426-2315