Provider Demographics
NPI:1922268416
Name:DIXON HEALTHCARE & REHABILITATION CENTER
Entity Type:Organization
Organization Name:DIXON HEALTHCARE & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESTERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-655-9104
Mailing Address - Street 1:800 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-4107
Mailing Address - Country:US
Mailing Address - Phone:815-284-3393
Mailing Address - Fax:815-284-2066
Practice Address - Street 1:800 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-4107
Practice Address - Country:US
Practice Address - Phone:815-284-3393
Practice Address - Fax:815-284-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid