Provider Demographics
NPI:1306180047
Name:MORTON TERRACE HEALTHCARE AND REHABILITATION CENTRE LLC
Entity Type:Organization
Organization Name:MORTON TERRACE HEALTHCARE AND REHABILITATION CENTRE LLC
Other - Org Name:MORTON TERRACE HEALTHCARE AND REHABILITATION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-897-9231
Mailing Address - Street 1:191 E QUEENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2956
Mailing Address - Country:US
Mailing Address - Phone:309-266-5331
Mailing Address - Fax:309-266-9376
Practice Address - Street 1:191 E QUEENWOOD RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2956
Practice Address - Country:US
Practice Address - Phone:309-266-5331
Practice Address - Fax:309-266-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145686Medicare PIN