Provider Demographics
NPI:1255476560
Name:ALHAMBRA CARE CENTER INC
Entity Type:Organization
Organization Name:ALHAMBRA CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-488-3565
Mailing Address - Street 1:417 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:IL
Mailing Address - Zip Code:62001-3035
Mailing Address - Country:US
Mailing Address - Phone:618-488-3565
Mailing Address - Fax:618-488-2517
Practice Address - Street 1:417 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:IL
Practice Address - Zip Code:62001-3035
Practice Address - Country:US
Practice Address - Phone:618-488-3565
Practice Address - Fax:618-488-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045609314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0045609Medicaid
IL146052Medicare Oscar/Certification