Provider Demographics
NPI:1609167006
Name:COLUMBIA REHABILITATION AND NURSING CENTER, LLC
Entity Type:Organization
Organization Name:COLUMBIA REHABILITATION AND NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHBAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-236-0000
Mailing Address - Street 1:8707 SKOKIE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2269
Mailing Address - Country:US
Mailing Address - Phone:708-236-0000
Mailing Address - Fax:708-236-0001
Practice Address - Street 1:253 BRADINGTON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2519
Practice Address - Country:US
Practice Address - Phone:618-281-6800
Practice Address - Fax:618-281-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0037556314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid