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General NPI Number Information
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NPI Number | 1831138890
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Entity Type | Organization
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Legal Business Name | ELMWOOD NURSING & REHABILITATION CENTER, L.L.C.
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 152 WILMA DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5435
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Country | US
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Telephone | 618-344-7750
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Fax | 618-344-3520
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Provider Business Mailing Address
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Address Line | 152 WILMA DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5435
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Country | US
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Telephone | 618-344-7750
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Fax | 618-344-3520
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Authorized Official
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Title or Position | MEMBER
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Name | MR. MAKHLOUF SUISSA
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Credential |
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Telephone | 618-344-7750
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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 | 0041210
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License Number State | IL
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