Provider Demographics
NPI:1497755094
Name:EDWARDSVILLE HEALTH CARE CENTER INVESTORS LLC
Entity Type:Organization
Organization Name:EDWARDSVILLE HEALTH CARE CENTER INVESTORS LLC
Other - Org Name:UNIVERSITY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-656-1081
Mailing Address - Street 1:1095 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3961
Mailing Address - Country:US
Mailing Address - Phone:618-656-1081
Mailing Address - Fax:618-656-7083
Practice Address - Street 1:1095 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3961
Practice Address - Country:US
Practice Address - Phone:618-656-1081
Practice Address - Fax:618-656-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046557314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
50288OtherBLUE CROSS BLUE SHIELD
71-00072OtherUNITED HEALTHCARE
71-00072OtherUNITED HEALTHCARE
14-5985Medicare ID - Type Unspecified
71-00072OtherUNITED HEALTHCARE