Provider Demographics
NPI:1790800654
Name:MOWEAQUA REHABILITATION & HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:MOWEAQUA REHABILITATION & HEALTH CARE CENTER, LLC
Other - Org Name:MOWEAQUA REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP HEALTHCARE ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:525 S MACON ST
Mailing Address - Street 2:
Mailing Address - City:MOWEAQUA
Mailing Address - State:IL
Mailing Address - Zip Code:62550-1337
Mailing Address - Country:US
Mailing Address - Phone:217-768-3951
Mailing Address - Fax:618-768-4971
Practice Address - Street 1:525 S MACON ST
Practice Address - Street 2:
Practice Address - City:MOWEAQUA
Practice Address - State:IL
Practice Address - Zip Code:62550-1337
Practice Address - Country:US
Practice Address - Phone:217-768-3951
Practice Address - Fax:618-768-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5105231310400000X
IL000045104314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000045104Medicaid
IL000045104Medicaid