Healthcare Provider Details

I. General information

NPI: 1942494950
Provider Name (Legal Business Name): PHOENIX REHABILITATION AND NURSING CARE, INC. NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 09/03/2007
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

615 W WEBB ST
CARMI IL
62821-1668
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-3892
  • Fax: 618-382-3892
Mailing address:
  • Phone: 618-382-3892
  • Fax: 618-382-3892

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: DR. ZAHID SAQIB
Title or Position: PRESIDENT
Credential:
Phone: 618-382-3892