MEDICARE: OREGON LIVING & 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	2056636	IL

General Provider Information

NPI Number	:	1255613691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON LIVING & REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	4950 MADISON ST STE 429
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-2570
Country	:	US
Telephone Number	:	847-982-2300
Fax Number	:	847-982-2304

Provider Business Practice Location Address
First Line	:	811 S 10TH ST
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-2129
Country	:	US
Telephone Number	:	815-732-7994
Fax Number	:	815-732-3165

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MOSHE HERMAN
Credential	:
Telephone Number	:	847-982-2300

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	07/25/2024

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