Provider Demographics
NPI:1013200153
Name:STOCKTON HEALTHCARE AND REHAB, INC
Entity Type:Organization
Organization Name:STOCKTON HEALTHCARE AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-4400
Mailing Address - Street 1:2711 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1303
Mailing Address - Country:US
Mailing Address - Phone:773-338-4400
Mailing Address - Fax:773-338-4414
Practice Address - Street 1:501 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-1444
Practice Address - Country:US
Practice Address - Phone:815-947-2215
Practice Address - Fax:815-947-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051268314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility