Provider Demographics
NPI:1104061662
Name:ELM CITY REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:ELM CITY REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOSNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-245-9504
Mailing Address - Street 1:1314 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1148
Mailing Address - Country:US
Mailing Address - Phone:217-245-9504
Mailing Address - Fax:217-245-2350
Practice Address - Street 1:575 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2926
Practice Address - Country:US
Practice Address - Phone:217-245-9504
Practice Address - Fax:217-245-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health