Provider Demographics
NPI:1831116904
Name:COMMUNITY NURSING & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:COMMUNITY NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:630-355-3300
Mailing Address - Street 1:1136 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2519
Mailing Address - Country:US
Mailing Address - Phone:630-355-3300
Mailing Address - Fax:630-355-9842
Practice Address - Street 1:1136 N MILL ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2519
Practice Address - Country:US
Practice Address - Phone:630-355-3300
Practice Address - Fax:630-355-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044750314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid