| NPI | 1306018759 |
|---|---|
| Doing Business As | PINE TERRACE |
| Entity Type | Organization |
| Authorized Contact | RONALD J WILSON Authorized Agent 309-343-1550 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: IL 43299) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-04-20 |