Provider Demographics
NPI:1508029919
Name:NILES NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:NILES NURSING & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-791-7859
Mailing Address - Street 1:9777 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1002
Mailing Address - Country:US
Mailing Address - Phone:847-967-7000
Mailing Address - Fax:847-967-5054
Practice Address - Street 1:9777 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1002
Practice Address - Country:US
Practice Address - Phone:847-967-7000
Practice Address - Fax:847-967-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility