Healthcare Provider Details

I. General information

NPI: 1013200153
Provider Name (Legal Business Name): STOCKTON HEALTHCARE AND REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E FRONT AVE
STOCKTON IL
61085-1444
US

IV. Provider business mailing address

2711 W HOWARD ST
CHICAGO IL
60645-1303
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-2215
  • Fax: 815-947-2027
Mailing address:
  • Phone: 773-338-4400
  • Fax: 773-338-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0051268
License Number StateIL

VIII. Authorized Official

Name: JOSEPH BRANDMAN
Title or Position: C.O.O
Credential:
Phone: 773-338-4400