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General NPI Number Information
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NPI Number | 1922798875
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Entity Type | Organization
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Legal Business Name | LITCHFIELD HEALTH AND REHAB CENTER LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 628 S ILLINOIS AVE
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City | LITCHFIELD
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State | IL
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Zip | 62056-2716
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Country | US
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Telephone | 217-324-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 575 ROUTE 70
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City | BRICK
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State | NJ
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Zip | 08723-4042
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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 | MANAGER OF THE MANAGER
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Name | SHULLY LICHTMAN
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Credential |
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Telephone | 217-324-2153
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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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