Organization
PALLADIAN AVISTON SNF LLC
Active
Other names
AVISTON COUNTRYSIDE MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JASON MILLS (CFO)
(314) 566-0459
Entity
Organization
Contact information
Practice address
450 W 1ST ST, AVISTON, IL 62216-3440
(618) 228-7615
(618) 228-7632
Mailing address
1670 ESSEX WAY STE B, O FALLON, IL 62269-3063
(618) 327-3064
(618) 327-3083
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1621197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3712129346221601
—
IL
Enumeration date
10/11/2005
Last updated
03/18/2024
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