Organization
NEW ATHENS HOME FOR THE AGED INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY WYNN HOLTGREWE (ADMINISTRATOR)
(618) 475-2550
Entity
Organization
Contact information
Practice address
203 S JOHNSON ST, NEW ATHENS, IL 62264-1319
(618) 475-2550
(618) 475-2567
Mailing address
203 S JOHNSON ST, NEW ATHENS, IL 62264-1319
(618) 475-2550
(618) 475-2567
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0033043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14-0061
—
IL
01
—
14E299
PUBLIC HEALTH ID #
IL
Enumeration date
03/16/2006
Last updated
08/06/2013
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