Provider Demographics
NPI:1689669517
Name:RICHLAND CARE AND REHAB
Entity Type:Organization
Organization Name:RICHLAND CARE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-395-7421
Mailing Address - Street 1:410 E MACK AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2319
Mailing Address - Country:US
Mailing Address - Phone:618-395-7421
Mailing Address - Fax:618-392-2973
Practice Address - Street 1:410 E MACK AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2319
Practice Address - Country:US
Practice Address - Phone:618-395-7421
Practice Address - Fax:618-392-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046797314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371370824001Medicaid
ILIL6006910OtherFACILITY ID NUMBER
ILIL6006910OtherFACILITY ID NUMBER
ILG42025Medicare UPIN
ILG85711Medicare UPIN
ILG45977Medicare UPIN
IL371370824001Medicaid
ILH14968Medicare UPIN
IL145388Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER