Healthcare Provider Details

I. General information

NPI: 1619632544
Provider Name (Legal Business Name): NATURE TRAIL HEALTH AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 34TH ST
MOUNT VERNON IL
62864-6232
US

IV. Provider business mailing address

575 ROUTE 70
BRICK NJ
08723-4042
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-5700
  • Fax:
Mailing address:
  • Phone:
  • 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: SHALOM LICHTMAN
Title or Position: MANAGER
Credential:
Phone: 618-242-5700