| NPI | 1790446383 |
|---|---|
| Doing Business As | IMBODEN CREEK SENIOR LIVING & REHABILITATION |
| Entity Type | Organization |
| Authorized Contact | SCOTT E STOUT Owner 618-294-8696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-04-25 |