MEDICARE: ATRIUM HEALTH CARE & REHABILITATION CENTER OF CAHOKIA L.P

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	0048645	IL

General Provider Information

NPI Number	:	1588847750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATRIUM HEALTH CARE & REHABILITATION CENTER OF CAHOKIA L.P

Provider Business Mailing Address
First Line	:	5151 CHURCH ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1123
Country	:	US
Telephone Number	:	847-933-9200
Fax Number	:	847-674-5794

Provider Business Practice Location Address
First Line	:	3354 JEROME LN
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-2604
Country	:	US
Telephone Number	:	618-337-9400
Fax Number	:	618-332-1811

Authorized Official
Title or Position	:	CONTRACT COORDINATOR
Name	:	MS. KIM M BOULTON
Credential	:
Telephone Number	:	847-933-9200

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	10/22/2024

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