Healthcare Provider Details

I. General information

NPI: 1205127628
Provider Name (Legal Business Name): CHESTER REHABILITATION AND NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 STATE ST
CHESTER IL
62233-1642
US

IV. Provider business mailing address

4213 MAIN ST
SKOKIE IL
60076-2046
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-2314
  • Fax: 618-826-5047
Mailing address:
  • Phone: 708-426-2315
  • Fax: 708-236-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0023390
License Number StateIL

VIII. Authorized Official

Name: MRS. ANETTA KOZLOWSKA
Title or Position: A/R DIRECTOR
Credential:
Phone: 708-236-0000