Provider Demographics
NPI:1720490972
Name:TONGANOXIE NURSING AND REHAB LLC
Entity Type:Organization
Organization Name:TONGANOXIE NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ARYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-440-2233
Mailing Address - Street 1:7383 N LINCOLN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1734
Mailing Address - Country:US
Mailing Address - Phone:847-440-2233
Mailing Address - Fax:
Practice Address - Street 1:1010 EAST ST
Practice Address - Street 2:STE 940
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-9557
Practice Address - Country:US
Practice Address - Phone:913-369-8705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS453135624001Medicaid
KS175215Medicare Oscar/Certification