Provider Demographics
NPI:1336221456
Name:RANCHO MANOR HEALTHCARE AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:RANCHO MANOR HEALTHCARE AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-2300
Mailing Address - Street 1:7434 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3341
Mailing Address - Country:US
Mailing Address - Phone:847-982-2300
Mailing Address - Fax:847-982-2304
Practice Address - Street 1:615 RANCHO LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1717
Practice Address - Country:US
Practice Address - Phone:314-839-2150
Practice Address - Fax:314-839-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265402Medicare Oscar/Certification