Healthcare Provider Details

I. General information

NPI: 1174997316
Provider Name (Legal Business Name): CARMI MANOR REHABILITATION AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 11/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W WEBB ST
CARMI IL
62821-1668
US

IV. Provider business mailing address

26 FIREMENS MEMORIAL DR
POMONA NY
10970-3553
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BORUCH SHEPS
Title or Position: MANAGER
Credential:
Phone: 315-497-0440