Provider Demographics
NPI:1174822266
Name:PARKER NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:PARKER NURSING & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHBAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-236-0000
Mailing Address - Street 1:240 FENCL LN
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2067
Mailing Address - Country:US
Mailing Address - Phone:708-529-4792
Mailing Address - Fax:708-240-4165
Practice Address - Street 1:516 W FRECH ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-1216
Practice Address - Country:US
Practice Address - Phone:815-672-2600
Practice Address - Fax:815-672-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2021816314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid