| NPI | 1528067865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER W BAGLEY Controller 618-549-8331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2020-08-22 |