Organization
BEVERLY ENTERPRISES - ILLINOIS, INC.
Active
Other names
Park Haven Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MERRELL (VICE PRESIDENT)
(479) 201-4840
Entity
Organization
Contact information
Practice address
107 S. LINCOLN, SMITHTON, IL 62285
(618) 235-4600
Mailing address
107 S. LINCOLN, SMITHTON, IL 62285
(618) 235-4600
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95-2301514017
—
IL
Enumeration date
10/03/2006
Last updated
08/22/2020
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