Organization
SOUTHERN ILLINOIS LIVING CENTERS INC.
Active
Other names
Clinton Manor Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A BRAVE MSW (VICE PRESIDENT ADMINISTRATOR)
(618) 588-2066
Entity
Organization
Contact information
Practice address
111 E ILLINOIS ST, NEW BADEN, IL 62265-1850
(618) 588-4924
(618) 588-4673
Mailing address
111 E ILLINOIS ST, NEW BADEN, IL 62265-1850
(618) 588-2066
(618) 588-4673
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0033159
IL
315P00000X
Intellectual Disabilities Intermediate Care Facility
0033159
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033159
IDPH LICENSE NUMBER
IL
Enumeration date
09/14/2005
Last updated
11/09/2011
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