Provider Demographics
NPI:1720145592
Name:HENDERSON COUNTY RETIREMENT CENTER, INC.
Entity Type:Organization
Organization Name:HENDERSON COUNTY RETIREMENT CENTER, INC.
Other - Org Name:OAKLANE NURSING & REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-924-1123
Mailing Address - Street 1:604 OAKWOOD DR
Mailing Address - Street 2:PO BOX 30
Mailing Address - City:STRONGHURST
Mailing Address - State:IL
Mailing Address - Zip Code:61480-0030
Mailing Address - Country:US
Mailing Address - Phone:309-924-1123
Mailing Address - Fax:309-924-1926
Practice Address - Street 1:604 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:STRONGHURST
Practice Address - State:IL
Practice Address - Zip Code:61480-0030
Practice Address - Country:US
Practice Address - Phone:309-924-1123
Practice Address - Fax:309-924-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000035246314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14A442OtherPROVIDER NUMBER
IL=========001Medicaid
IL14A442OtherPROVIDER NUMBER