| NPI | 1881679579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM WITTENBERG Administrator 815-844-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IL 1630299) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IL 1630299) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-08-12 |