Healthcare Provider Details

I. General information

NPI: 1063351096
Provider Name (Legal Business Name): MASCOUTAH NURSING AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 10TH ST
MASCOUTAH IL
62258-1736
US

IV. Provider business mailing address

7373 N LINCOLN AVE STE 300
LINCOLNWOOD IL
60712-1715
US

V. Phone/Fax

Practice location:
  • Phone: 618-566-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: AKIVA GARFINKEL
Title or Position: PRESIDENT
Credential:
Phone: 773-899-6924