Provider Demographics
NPI:1447889886
Name:LACON REHAB AND NURSING LLC
Entity type:Organization
Organization Name:LACON REHAB AND NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-414-3300
Mailing Address - Street 1:7B MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3516
Mailing Address - Country:US
Mailing Address - Phone:845-414-3300
Mailing Address - Fax:845-517-4796
Practice Address - Street 1:401 9TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1140
Practice Address - Country:US
Practice Address - Phone:309-246-2175
Practice Address - Fax:309-246-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6008999Medicaid