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NPI Code Detail

MEDICARE: PCNR, LLC

MEDICARE: PCNR, 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
1311Z00000XCustodial Care Facility
2313M00000XNursing Facility/Intermediate Care Facility

General Provider Information

NPI Number : 1821417452
Entity Type Code : Organization
Provider Name (Legal Business Name) : PCNR, LLC
Provider Business Mailing Address
First Line : 7444 LONG AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3214
Country : US
Telephone Number : 847-329-4100
Fax Number :
Provider Business Practice Location Address
First Line : 6120 MORNINGSIDE AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3943
Country : US
Telephone Number : 712-276-3000
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : BENJAMIN KLEIN
Credential :
Telephone Number : 847-329-4100
Provider Enumeration Date : 04/10/2014
Last Update Date : 04/10/2014

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