Organization
VANDALIA ESTATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HOLTZ (CONTROLLER)
(541) 747-3373
Entity
Organization
Contact information
Practice address
1607 W FILLMORE ST, VANDALIA, IL 62471-3112
(618) 283-9825
(618) 283-9926
Mailing address
78 CENTENNIAL LOOP, EUGENE, OR 97401-7900
(541) 747-3373
(541) 747-0673
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
06/21/2007
Last updated
05/14/2008
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