Provider Demographics
NPI:1508334780
Name:LOFT REHABILITATION AND NURSING OF NORMAL LLC
Entity Type:Organization
Organization Name:LOFT REHABILITATION AND NURSING OF NORMAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:846-679-8219
Mailing Address - Street 1:3359 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2432
Mailing Address - Country:US
Mailing Address - Phone:847-679-8219
Mailing Address - Fax:847-679-7377
Practice Address - Street 1:510 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3762
Practice Address - Country:US
Practice Address - Phone:309-452-4406
Practice Address - Fax:309-454-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility