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Organization
ILLINOIS VETERANS HOME AT MANTENO
Active
Organization
ILLINOIS VETERANS HOME AT MANTENO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINALD L BOOKER LNHA (ADMINISTRATOR)
(815) 468-6581
Entity
Organization
Contact information
Practice address
1 VETERANS DR, MANTENO, IL 60950-9466
(815) 468-6581
(815) 468-7001
Mailing address
1 VETERANS DR, BLDG A-2M, MANTENO, IL 60950-9466
(217) 222-9487
(217) 222-8578
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
0042218
IL
320700000X
Physical Disabilities Residential Treatment Facility
Primary
0042218
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
01/09/2007
Last updated
07/15/2010
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