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General NPI Number Information
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NPI Number | 1710138961
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Entity Type | Organization
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Legal Business Name | MOMENCE MEADOWS NURSING AND REHABILITATION CENTER
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 500 S WALNUT ST
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City | MOMENCE
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State | IL
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Zip | 60954-1814
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Country | US
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Telephone | 815-472-2423
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Fax | 815-472-6212
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Provider Business Mailing Address
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Address Line | 500 S WALNUT ST
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City | MOMENCE
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State | IL
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Zip | 60954-1814
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Country | US
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Telephone | 815-472-2423
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Fax | 815-472-6212
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Authorized Official
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Title or Position | CONTROLLER
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Name | MELISSA DYER
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Credential |
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Telephone | 815-472-2423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0048033
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License Number State | IL
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