MEDICARE: HILLSIDE MANOR HEALTHCARE & REHAB. CENTER

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	032084	MO

General Provider Information

NPI Number	:	1275507139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSIDE MANOR HEALTHCARE & REHAB. CENTER

Provider Business Mailing Address
First Line	:	7434 SKOKIE BLVD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3341
Country	:	US
Telephone Number	:	847-982-2300
Fax Number	:	847-982-2304

Provider Business Practice Location Address
First Line	:	1265 MCLARAN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63147-1655
Country	:	US
Telephone Number	:	314-388-4121
Fax Number	:	314-388-5926

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MOE HERMAN
Credential	:
Telephone Number	:	847-982-2300

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/22/2020

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