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General NPI Number Information
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NPI Number | 1841010337
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Entity Type | Organization
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Legal Business Name | EVERCARE OF JERSEYVILLE LLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 410 FLETCHER ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2127
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Country | US
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Telephone | 618-498-6427
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60076-3407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | YEHUDA ROSENBLATT
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Credential |
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Telephone | 618-498-6427
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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 |
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License Number State |
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