Healthcare Provider Details

I. General information

NPI: 1568467306
Provider Name (Legal Business Name): MERCY REHAB AND CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSEWOOD VILLAGE DR
SWANSEA IL
62226-2301
US

IV. Provider business mailing address

11861 WESTLINE INDUSTRIAL DR SUITE 150
SAINT LOUIS MO
63146-3305
US

V. Phone/Fax

Practice location:
  • Phone: 618-236-1391
  • Fax:
Mailing address:
  • Phone: 314-548-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0032680
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1303590001
License Number StateIL

VIII. Authorized Official

Name: LARRY VANDER MATEN
Title or Position: PRESIDENT
Credential:
Phone: 314-548-2250