Organization
APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD D ISAIA (ADMINISTRATOR)
(309) 923-2071
Entity
Organization
Contact information
Practice address
1102 W RANDOLPH ST, ROANOKE, IL 61561-7528
(309) 923-2071
(309) 923-7919
Mailing address
1102 W RANDOLPH ST, P.O. BOX 530, ROANOKE, IL 61561-7528
(309) 923-2071
(309) 923-7919
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0021493
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021493
—
IL
Enumeration date
10/20/2006
Last updated
07/27/2016
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