Organization
HENRY & JANE VONDERLIETH LIVING CENTER, INC
Active
Other names
Henry & Jane Vonderlieth Living Center, The H & J Vonderlieth LVG CTR
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M UNDERWOOD CPA (EXEC VP, CFO)
(308) 823-7135
Entity
Organization
Contact information
Practice address
1120 N TOPPER DR, MOUNT PULASKI, IL 62548-1401
(217) 792-3218
(217) 792-3210
Mailing address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-5477
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
11/06/2012
Last updated
05/30/2017
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