Healthcare Provider Details

I. General information

NPI: 1962654608
Provider Name (Legal Business Name): DOUGLAS REHAB AND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 W POWELL LN
MATTOON IL
61938-2266
US

IV. Provider business mailing address

1625 S 6TH ST
SPRINGFIELD IL
62703-2828
US

V. Phone/Fax

Practice location:
  • Phone: 217-234-6401
  • Fax:
Mailing address:
  • Phone: 217-528-2244
  • 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: MRS. MARY E STROISCH
Title or Position: DIR OF FIN SERV
Credential:
Phone: 217-528-2244