Provider Demographics
NPI:1407598865
Name:ST ANTHONYS REHABILITATION AND NURSING CENTER LLC
Entity Type:Organization
Organization Name:ST ANTHONYS REHABILITATION AND NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-315-5037
Mailing Address - Street 1:767 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-1945
Mailing Address - Country:US
Mailing Address - Phone:309-788-7631
Mailing Address - Fax:
Practice Address - Street 1:767 30TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-1945
Practice Address - Country:US
Practice Address - Phone:309-788-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility