MEDICARE: CLARK NURSING AND REHABILITATION 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
1	314000000X	Skilled Nursing Facility	5200	IN

General Provider Information

NPI Number	:	1114046463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK NURSING AND REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	1964 CLARK RD
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-2550
Country	:	US
Telephone Number	:	219-949-9640
Fax Number	:	219-949-9693

Provider Business Practice Location Address
First Line	:	1964 CLARK RD
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-2550
Country	:	US
Telephone Number	:	219-949-9640
Fax Number	:	219-949-9693

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MARK STEINGBERG
Credential	:
Telephone Number	:	847-905-3000

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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