Healthcare Provider Details

I. General information

NPI: 1770570418
Provider Name (Legal Business Name): REHAB & CARE CENTER OF JACKSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 14TH ST
MURPHYSBORO IL
62966-2982
US

IV. Provider business mailing address

1441 N 14TH ST
MURPHYSBORO IL
62966-2982
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-2136
  • Fax: 618-684-5710
Mailing address:
  • Phone: 618-684-2136
  • Fax: 618-684-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number145395
License Number StateIL

VIII. Authorized Official

Name: MRS. MERLE K TAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 618-684-2136