Provider Demographics
NPI:1770570418
Name:REHAB & CARE CENTER OF JACKSON COUNTY
Entity type:Organization
Organization Name:REHAB & CARE CENTER OF JACKSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-684-2136
Mailing Address - Street 1:1441 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2982
Mailing Address - Country:US
Mailing Address - Phone:618-684-2136
Mailing Address - Fax:618-684-5710
Practice Address - Street 1:1441 N 14TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2982
Practice Address - Country:US
Practice Address - Phone:618-684-2136
Practice Address - Fax:618-684-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
IL145395314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000010330Medicaid
IL1390OtherOPERATION LICENSE
IL145395Medicare ID - Type UnspecifiedMEDICARE