MEDICARE: CAHOKIA NURSING AND REHABILITATION 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0039636	IL

General Provider Information

NPI Number	:	1306011051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAHOKIA NURSING AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	2 ANNABLE CT
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-2204
Country	:	US
Telephone Number	:	847-982-2300
Fax Number	:	847-982-2304

Provider Business Practice Location Address
First Line	:	2 ANNABLE CT
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-2204
Country	:	US
Telephone Number	:	847-982-2300
Fax Number	:	847-982-2304

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	02/20/2023

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