Healthcare Provider Details

I. General information

NPI: 1033648332
Provider Name (Legal Business Name): ELDORADO REHAB & HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001A JEFFERSON ST
ELDORADO IL
62930-1373
US

IV. Provider business mailing address

1001A JEFFERSON ST
ELDORADO IL
62930-1373
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-3353
  • Fax:
Mailing address:
  • Phone: 618-273-3353
  • 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: MR. SCOTT E STOUT
Title or Position: CEO
Credential:
Phone: 618-294-8696