Healthcare Provider Details

I. General information

NPI: 1871173112
Provider Name (Legal Business Name): MACOMB POST ACUTE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DOCTORS LN
MACOMB IL
61455-3310
US

IV. Provider business mailing address

7B MEDICAL PARK DR
POMONA NY
10970-3516
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-5555
  • Fax:
Mailing address:
  • Phone: 845-414-3300
  • Fax: 845-517-4796

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: CHAIM MILLMAN
Title or Position: CEO
Credential:
Phone: 845-414-3300