| NPI | 1568463644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL DIVORA Administrative Assistant 815-452-2367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IL 0042796) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IL 0042796) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-08-22 |