| NPI | 1942367453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. KOEHLER Administrator 815-223-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: IL 44115) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: IL 44115) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2013-05-24 |