Provider Demographics
NPI:1790475648
Name:PANA HEALTH AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:PANA HEALTH AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF THE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHULLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-562-2174
Mailing Address - Street 1:575 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1870
Practice Address - Country:US
Practice Address - Phone:217-562-2174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility