Healthcare Provider Details

I. General information

NPI: 1104160845
Provider Name (Legal Business Name): RIVERSHORES HEALTHCARE AND REHABILITATION CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 COMMERCIAL ST
MARSEILLES IL
61341-1814
US

IV. Provider business mailing address

578 COMMERCIAL ST
MARSEILLES IL
61341-1814
US

V. Phone/Fax

Practice location:
  • Phone: 815-795-5121
  • Fax: 815-795-6213
Mailing address:
  • Phone: 815-795-5121
  • Fax: 815-795-6213

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: MS. KATHLEEN ADAMS
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLES
Credential:
Phone: 773-897-9231