Provider Demographics
NPI:1104110816
Name:STOCKTON HEALTHCARE AND REHAB CENTER INC
Entity type:Organization
Organization Name:STOCKTON HEALTHCARE AND REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-4400
Mailing Address - Street 1:501 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-1444
Mailing Address - Country:US
Mailing Address - Phone:815-947-2215
Mailing Address - Fax:815-947-2561
Practice Address - Street 1:501 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:IL
Practice Address - Zip Code:61085-1444
Practice Address - Country:US
Practice Address - Phone:815-947-2215
Practice Address - Fax:815-947-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000051268314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid