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Organization
DECATUR MANOR HEALTHCARE, LLC
Active
Organization
DECATUR MANOR HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS WINTER CPA (CFO)
(847) 675-7979
Entity
Organization
Contact information
Practice address
1016 W PERSHING RD, DECATUR, IL 62526-1541
(217) 875-0833
(217) 875-6851
Mailing address
6840 N LINCOLN AVE, LINCOLNWOOD, IL 60712-2628
(847) 675-7979
(847) 675-0555
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
0049262
IL
310500000X
Mental Illness Intermediate Care Facility
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31CX5
—
IL
05
—
370969602
—
IL
05
—
612731133
—
IL
Enumeration date
07/07/2005
Last updated
09/09/2013
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