Provider Demographics
NPI:1295818284
Name:YORKVILLE CARE CENTER LLC
Entity Type:Organization
Organization Name:YORKVILLE CARE CENTER LLC
Other - Org Name:HILLSIDE REHABILITATION & CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER OF UC
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-0044
Mailing Address - Street 1:1625 S 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2828
Mailing Address - Country:US
Mailing Address - Phone:217-528-0044
Mailing Address - Fax:217-528-3412
Practice Address - Street 1:1308 GAME FARM ROAD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-553-5811
Practice Address - Fax:630-553-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL145609Medicare ID - Type Unspecified