Provider Demographics
NPI:1205127628
Name:CHESTER REHABILITATION AND NURSING CENTER, LLC
Entity type:Organization
Organization Name:CHESTER REHABILITATION AND NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-236-0000
Mailing Address - Street 1:4213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2046
Mailing Address - Country:US
Mailing Address - Phone:708-426-2315
Mailing Address - Fax:708-236-0001
Practice Address - Street 1:770 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1642
Practice Address - Country:US
Practice Address - Phone:618-826-2314
Practice Address - Fax:618-826-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0023390314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145475Medicare Oscar/Certification