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NPI Code Detail

MEDICARE: CARBONDALE REHABILITATION AND NURSING CENTER, LLC

MEDICARE: CARBONDALE REHABILITATION AND NURSING CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0041418IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16009203OTHERILFACILITY ID

General Provider Information

NPI Number : 1063518850
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARBONDALE REHABILITATION AND NURSING CENTER, LLC
Provider Business Mailing Address
First Line : 8707 SKOKIE BLVD
Second Line : SUITE 310
City : SKOKIE
State : IL
Zip : 60077-2269
Country : US
Telephone Number : 708-236-0000
Fax Number : 708-236-0001
Provider Business Practice Location Address
First Line : 120 N TOWER RD
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1929
Country : US
Telephone Number : 618-549-3355
Fax Number : 618-549-0484
Authorized Official
Title or Position : C.F.O
Name : MR. STEVEN BLISKO
Credential :
Telephone Number : 708-236-0000
Provider Enumeration Date : 09/16/2006
Last Update Date : 03/30/2011

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