Healthcare Provider Details

I. General information

NPI: 1831309988
Provider Name (Legal Business Name): WOOD RIVER HEALTHCARE & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E EDWARDSVILLE RD
WOOD RIVER IL
62095-1646
US

IV. Provider business mailing address

4213 MAIN ST
SKOKIE IL
60076-2046
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-4111
  • Fax: 708-236-0001
Mailing address:
  • Phone: 708-426-2315
  • Fax: 708-236-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number38661
License Number StateIL

VIII. Authorized Official

Name: STEVEN BLISKO
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 708-426-2315