Healthcare Provider Details

I. General information

NPI: 1255613691
Provider Name (Legal Business Name): OREGON LIVING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S 10TH ST
OREGON IL
61061-2129
US

IV. Provider business mailing address

4950 MADISON ST STE 429
SKOKIE IL
60077-2570
US

V. Phone/Fax

Practice location:
  • Phone: 815-732-7994
  • Fax: 815-732-3165
Mailing address:
  • Phone: 847-982-2300
  • Fax: 847-982-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2056636
License Number StateIL

VIII. Authorized Official

Name: MR. MOSHE HERMAN
Title or Position: MEMBER
Credential:
Phone: 847-982-2300