Provider Demographics
NPI:1104160845
Name:RIVERSHORES HEALTHCARE AND REHABILITATION CENTRE LLC
Entity type:Organization
Organization Name:RIVERSHORES HEALTHCARE AND REHABILITATION CENTRE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-897-9231
Mailing Address - Street 1:578 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-1814
Mailing Address - Country:US
Mailing Address - Phone:815-795-5121
Mailing Address - Fax:815-795-6213
Practice Address - Street 1:578 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1814
Practice Address - Country:US
Practice Address - Phone:815-795-5121
Practice Address - Fax:815-795-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145295Medicare PIN