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NPI Code Detail

MEDICARE: WOOD RIVER HEALTHCARE & REHABILITATION CENTER LLC

MEDICARE: WOOD RIVER HEALTHCARE & REHABILITATION 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 Facility38661IL

General Provider Information

NPI Number : 1831309988
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOOD RIVER HEALTHCARE & REHABILITATION CENTER LLC
Provider Business Mailing Address
First Line : 4213 MAIN ST
Second Line :
City : SKOKIE
State : IL
Zip : 60076-2046
Country : US
Telephone Number : 708-426-2315
Fax Number : 708-236-0001
Provider Business Practice Location Address
First Line : 393 E EDWARDSVILLE RD
Second Line :
City : WOOD RIVER
State : IL
Zip : 62095-1646
Country : US
Telephone Number : 618-259-4111
Fax Number : 708-236-0001
Authorized Official
Title or Position : AUTHORIZED REPRESENTATIVE
Name : STEVEN BLISKO
Credential :
Telephone Number : 708-426-2315
Provider Enumeration Date : 05/23/2007
Last Update Date : 02/28/2022

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