Provider Demographics
NPI:1831309988
Name:WOOD RIVER HEALTHCARE & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:WOOD RIVER HEALTHCARE & REHABILITATION CENTER LLC
Other - Org Name:INTEGRITY HEALTHCARE OF WOOD RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-426-2315
Mailing Address - Street 1:4213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2046
Mailing Address - Country:US
Mailing Address - Phone:708-426-2315
Mailing Address - Fax:708-236-0001
Practice Address - Street 1:393 E EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1646
Practice Address - Country:US
Practice Address - Phone:618-259-4111
Practice Address - Fax:708-236-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38661314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA145655Medicare Oscar/Certification
IL145655Medicare Oscar/Certification