| NPI | 1861818031 |
|---|---|
| Doing Business As | PINE TERRACE |
| Entity Type | Organization |
| Authorized Contact | RONALD J WILSON Authorized Agent 309-343-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-12 |