MEDICARE: COMMUNITY CARE CENTER OF MONMOUTH, INC

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	0027979	IL

General Provider Information

NPI Number	:	1720084759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE CENTER OF MONMOUTH, INC

Provider Business Mailing Address
First Line	:	437 SOVEREIGN CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4432
Country	:	US
Telephone Number	:	636-394-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 S I ST
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1544
Country	:	US
Telephone Number	:	309-734-3811
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTINA M GIARDINA
Credential	:
Telephone Number	:	636-394-3000

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/04/2021

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