Provider Demographics
NPI:1457659740
Name:ALTON REHABILITATION AND NURSING CENTER, LLC.
Entity Type:Organization
Organization Name:ALTON REHABILITATION AND NURSING CENTER, LLC.
Other - Org Name:INTEGRITY HEALTHCARE OF ALTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:IRNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-426-2315
Mailing Address - Street 1:3523 WICKENHAUSER
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2118
Mailing Address - Country:US
Mailing Address - Phone:618-465-8887
Mailing Address - Fax:618-465-1811
Practice Address - Street 1:3523 WICKENHAUSER AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-2118
Practice Address - Country:US
Practice Address - Phone:618-465-8887
Practice Address - Fax:618-465-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051334314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145427Medicare Oscar/Certification