Healthcare Provider Details

I. General information

NPI: 1336969823
Provider Name (Legal Business Name): EVERCARE OF COLLINSVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 SUMMIT AVE
COLLINSVILLE IL
62234-3728
US

IV. Provider business mailing address

3700 OAKTON ST
SKOKIE IL
60076-3407
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-8476
  • 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: YEHUDA ROSENBLATT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 618-344-8476