| NPI | 1982602330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN L NOFFKE Administrator 217-693-5015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IL 0001636) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IL 0001636) |
| 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies (Licence: IL 001636) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: IL 001636) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2013-03-04 |