Provider Demographics
NPI:1922114057
Name:MERCY HEALTH CARE AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:MERCY HEALTH CARE AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-677-7777
Mailing Address - Street 1:4101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2753
Mailing Address - Country:US
Mailing Address - Phone:847-677-7777
Mailing Address - Fax:847-677-7796
Practice Address - Street 1:19000 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4204
Practice Address - Country:US
Practice Address - Phone:708-957-9200
Practice Address - Fax:708-799-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid