Organization
CENTRAL ILLINOIS SNF CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHAVIN VALLABHBHAI SONANI (PRESIDENT / OWNER)
(630) 336-5620
Entity
Organization
Contact information
Practice address
1517 W WALNUT ST, JACKSONVILLE, IL 62650-1133
(630) 336-5620
Mailing address
1517 W WALNUT ST, JACKSONVILLE, IL 62650-1133
(630) 336-5620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100967946
MEDICARE GROUP PTAN
IL
Enumeration date
05/18/2023
Last updated
10/03/2023
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