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NPI Code Detail

MEDICARE: MOUNT ZION HEALTH AND REHAB CENTER LLC

MEDICARE: MOUNT ZION HEALTH AND REHAB 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1457041303
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNT ZION HEALTH AND REHAB CENTER LLC
Provider Business Mailing Address
First Line : 575 ROUTE 70
Second Line :
City : BRICK
State : NJ
Zip : 08723-4042
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1225 WOODLAND DR
Second Line :
City : MT ZION
State : IL
Zip : 62549-1237
Country : US
Telephone Number : 217-864-2356
Fax Number :
Authorized Official
Title or Position : MANAGER OF THE MANAGER
Name : SHULLY LICHTMAN
Credential :
Telephone Number : 217-864-2356
Provider Enumeration Date : 05/12/2023
Last Update Date : 05/12/2023

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