Healthcare Provider Details

I. General information

NPI: 1447249081
Provider Name (Legal Business Name): EAST ROCHELLE NURSING AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N CARON RD
ROCHELLE IL
61068-9647
US

IV. Provider business mailing address

1021 N CARON RD
ROCHELLE IL
61068-9647
US

V. Phone/Fax

Practice location:
  • Phone: 815-562-4047
  • Fax: 815-562-6689
Mailing address:
  • Phone: 815-562-4047
  • Fax: 815-562-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0044867
License Number StateIL

VIII. Authorized Official

Name: MR. ELISHA ATKIN
Title or Position: MANAGER
Credential: LICENSE NH ADMIN
Phone: 847-470-0000