MEDICARE: MONMOUTH REHAB AND NURSING 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

General Provider Information

NPI Number	:	1194524975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONMOUTH REHAB AND NURSING LLC

Provider Business Mailing Address
First Line	:	117 S I ST
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1544
Country	:	US
Telephone Number	:	309-734-3811
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 S I ST
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1544
Country	:	US
Telephone Number	:	309-734-3811
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BENJAMIN FRIEDMAN
Credential	:
Telephone Number	:	845-414-3300

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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