| NPI | 1023097151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE LUCKETT Administrator 618-273-3353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IL 0020628) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: IL 0020628) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-08-22 |