# DECATUR MANOR HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134126063
- **Authorized official:** MR. THOMAS WINTER CPA (CFO)
- **Authorized official phone:** (847) 675-7979

## Contact information

- **Practice address:** 1016 W PERSHING RD, DECATUR, IL 62526-1541
- **Practice address phone:** (217) 875-0833
- **Practice address fax:** (217) 875-6851
- **Mailing address:** 6840 N LINCOLN AVE, LINCOLNWOOD, IL 60712-2628
- **Mailing address phone:** (847) 675-7979
- **Mailing address fax:** (847) 675-0555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310500000X | Mental Illness Intermediate Care Facility | 0049262 | IL | Yes |
| 310500000X | Mental Illness Intermediate Care Facility | — | NULL | — |

## Other

- **Enumeration date:** 07/07/2005
- **Last updated:** 09/09/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 31CX5 | — | IL |
| 05 | — | 370969602 | — | IL |
| 05 | — | 612731133 | — | IL |