Provider Demographics
NPI:1235422130
Name:HAMILTON MEMORIAL NURSING AND REHABILITATION CENTER, L.L.C.
Entity Type:Organization
Organization Name:HAMILTON MEMORIAL NURSING AND REHABILITATION CENTER, L.L.C.
Other - Org Name:HAMILTON MEMORIAL REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:609 S MARSHALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCLEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859
Mailing Address - Country:US
Mailing Address - Phone:618-643-2325
Mailing Address - Fax:618-643-3528
Practice Address - Street 1:609 S MARSHALL AVENUE
Practice Address - Street 2:
Practice Address - City:MCLEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859
Practice Address - Country:US
Practice Address - Phone:618-643-2325
Practice Address - Fax:618-643-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL146146Medicare Oscar/Certification