| NPI | 1427499052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BONTA Regional Director 618-541-4536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IL 146.003911) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |