Provider Demographics
NPI:1306011051
Name:CAHOKIA NURSING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:CAHOKIA NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-2300
Mailing Address - Street 1:2 ANNABLE CT
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2204
Mailing Address - Country:US
Mailing Address - Phone:847-982-2300
Mailing Address - Fax:847-982-2304
Practice Address - Street 1:2 ANNABLE CT
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2204
Practice Address - Country:US
Practice Address - Phone:847-982-2300
Practice Address - Fax:847-982-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039636332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies