Provider Demographics
NPI:1013904739
Name:SALEM VILLAGE NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:SALEM VILLAGE NURSING AND REHABILITATION CENTER LLC
Other - Org Name:SALEM VILLAGE NURSING AND REHABILITATION CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-963-7570
Mailing Address - Street 1:1314 ROWELL AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-2866
Mailing Address - Country:US
Mailing Address - Phone:815-727-5451
Mailing Address - Fax:815-727-2798
Practice Address - Street 1:1314 ROWELL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2866
Practice Address - Country:US
Practice Address - Phone:815-727-5451
Practice Address - Fax:815-727-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1308220001Medicare NSC
IL145618Medicare ID - Type UnspecifiedPROVIDER NUMBER