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Organization
SOUTHERN ILLINOIS LIVING CENTERS INC.
Active
Organization
SOUTHERN ILLINOIS LIVING CENTERS INC.
Active
Other names
Clitnon Manor Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ALBERT BRAVE (ADMINISTRATOR)
(618) 588-2066
Entity
Organization
Contact information
Practice address
111 E ILLINOIS ST, NEW BADEN, IL 62265-1850
(618) 588-2066
(618) 588-4673
Mailing address
300 E ILLINOIS ST, NEW BADEN, IL 62265-1822
(618) 588-2066
(618) 588-4673
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0033159
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371224393003
—
IL
Enumeration date
09/15/2010
Last updated
09/15/2010
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