Provider Demographics
NPI:1942207832
Name:CARBONDALE REHABILITATION AND NURSING CENTER II LLC
Entity Type:Organization
Organization Name:CARBONDALE REHABILITATION AND NURSING CENTER II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-236-0000
Mailing Address - Street 1:8707 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2269
Mailing Address - Country:US
Mailing Address - Phone:708-236-0000
Mailing Address - Fax:
Practice Address - Street 1:500 S LEWIS LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3448
Practice Address - Country:US
Practice Address - Phone:618-529-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046920314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0046920OtherFACILITY LICENSE NUMBER
IL146079Medicare Oscar/Certification