Healthcare Provider Details

I. General information

NPI: 1720439110
Provider Name (Legal Business Name): THE LOFT REHABILITATION AND NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N MAIN ST
EUREKA IL
61530-1085
US

IV. Provider business mailing address

700 N MAIN ST
EUREKA IL
61530-1085
US

V. Phone/Fax

Practice location:
  • Phone: 309-467-2337
  • Fax: 309-467-9011
Mailing address:
  • Phone: 309-467-2337
  • Fax: 309-467-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FRED AARON
Title or Position: MANAGER
Credential:
Phone: 847-814-2000