=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881425056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANVILLE NURSING AND REHAB CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2024
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 N BOWMAN AVENUE RD
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61832-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-443-2955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7373 N LINCOLN AVE STE 300
-----------------------------------------------------
City | LINCOLNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60712-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED REPRESENTATIVE
-----------------------------------------------------
Name | ALLAN GARFINKEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-210-1578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------