Provider Demographics
NPI:1811997760
Name:CARLINVILLE REHABILITATION AND HEALTH CARE CENTER, LLC
Entity type:Organization
Organization Name:CARLINVILLE REHABILITATION AND HEALTH CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:751 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1059
Mailing Address - Country:US
Mailing Address - Phone:217-854-2511
Mailing Address - Fax:217-854-4377
Practice Address - Street 1:751 N OAK ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1059
Practice Address - Country:US
Practice Address - Phone:217-854-2511
Practice Address - Fax:217-854-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0030411314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL510271905019Medicaid
IL145454Medicare Oscar/Certification