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Organization subpart
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Provider details

NPI number
Authorized official
RANDY LAW (EXECUTIVE ADMINISTRATOR)
(618) 234-1992
Entity
Organization

Contact information

Practice address
3001 SAVE RD, BELLEVILLE, IL 62221-7018
(618) 234-1992
Mailing address
114 S MARKET ST, MASCOUTAH, IL 62258-2432

Taxonomy

Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
041.180759
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0515
IL
Enumeration date
04/17/2015
Last updated
04/17/2015
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