Healthcare Provider Details

I. General information

NPI: 1831646611
Provider Name (Legal Business Name): EDWARDSVILLE CARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BLAKE ST
EDWARDSVILLE KS
66111-1338
US

IV. Provider business mailing address

751 BLAKE ST
EDWARDSVILLE KS
66111-1338
US

V. Phone/Fax

Practice location:
  • Phone: 913-441-1900
  • Fax: 913-441-0410
Mailing address:
  • Phone: 913-441-1900
  • Fax: 913-441-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 201-635-1195