MEDICARE: CARE CENTER OF JACKSONVILLE, 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1225344518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE CENTER OF JACKSONVILLE, LLC

Provider Business Mailing Address
First Line	:	8131 MONTICELLO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3325
Country	:	US
Telephone Number	:	847-673-6767
Fax Number	:	847-673-6768

Provider Business Practice Location Address
First Line	:	1320 TENDICK ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3121
Country	:	US
Telephone Number	:	217-243-6405
Fax Number	:	217-245-1449

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. YOSEF MEYSTEL
Credential	:
Telephone Number	:	847-673-6767

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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