Healthcare Provider Details

I. General information

NPI: 1467110593
Provider Name (Legal Business Name): MEADOW BROOK SKILLED NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 2ND ST
GRAYVILLE IL
62844-1527
US

IV. Provider business mailing address

575 ROUTE 70
BRICK NJ
08723-4042
US

V. Phone/Fax

Practice location:
  • Phone: 618-375-2171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MEIR SINGER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 618-375-2171