Healthcare Provider Details

I. General information

NPI: 1922103589
Provider Name (Legal Business Name): MARION REHABILITATION AND NURSING CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E DEYOUNG ST
MARION IL
62959-3846
US

IV. Provider business mailing address

8707 SKOKIE BLVD SUITE 310
SKOKIE IL
60077-2269
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-1365
  • Fax: 618-998-9300
Mailing address:
  • Phone: 708-236-0000
  • Fax: 708-236-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0040642
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN BLIKSO
Title or Position: C.F.O
Credential:
Phone: 708-236-0000