Healthcare Provider Details

I. General information

NPI: 1700850526
Provider Name (Legal Business Name): CASEYVILLE NURSING & REHABILITATION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LINCOLN AVE
CASEYVILLE IL
62232-1306
US

IV. Provider business mailing address

3856 OAKTON ST STE 250
SKOKIE IL
60076-3454
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-3072
  • Fax: 618-345-3170
Mailing address:
  • Phone: 847-982-2300
  • Fax: 847-982-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0039644
License Number StateIL

VIII. Authorized Official

Name: MOE HERMAN
Title or Position: COMPTROLLER
Credential:
Phone: 847-982-2300