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1134582018
BACKROAD HEALTH CARE INC
CENTRALIA, IL
NPI
1134582018
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Entity Type
Organization
Authorized Contact
PAUL S HAVRILKA
Fnp/Owner
618-419-0011
Organization Subpart ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
Enumeration Date
2016-03-30
Last Update Date
2019-03-18
Business Address
BACKROAD HEALTH CARE INC
211 S PERRINE AVE
CENTRALIA, IL 62801-3635
Phone number: 618-419-0011
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Mailing Address
BACKROAD HEALTH CARE INC
314 S POPLAR ST UNIT 864
CENTRALIA, IL 62801-0848
Phone number: 618-419-0011
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