Healthcare Provider Details

I. General information

NPI: 1386142776
Provider Name (Legal Business Name): MEDINA NURSING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S CENTER ST
DURAND IL
61024-9590
US

IV. Provider business mailing address

402 S CENTER ST
DURAND IL
61024-9590
US

V. Phone/Fax

Practice location:
  • Phone: 815-248-2151
  • Fax: 815-248-2771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0011551
License Number StateIL

VIII. Authorized Official

Name: LAURA WAINWRIGHT
Title or Position: ADMIN ASSISTANT
Credential: DO
Phone: 815-248-2151