Provider Demographics
NPI:1962654608
Name:DOUGLAS REHAB AND CARE CENTER
Entity Type:Organization
Organization Name:DOUGLAS REHAB AND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FIN SERV
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:STROISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-2244
Mailing Address - Street 1:1625 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2828
Mailing Address - Country:US
Mailing Address - Phone:217-528-2244
Mailing Address - Fax:
Practice Address - Street 1:3516 W POWELL LN
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-2266
Practice Address - Country:US
Practice Address - Phone:217-234-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid