Organization
WC- MATTOON NORTH OPS, LLC
Active
Other names
Brookstone Of Mattoon North
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT RUSSELL (EXECUTIVE DIRECTOR)
(217) 235-5881
Entity
Organization
Contact information
Practice address
1920 BROOKSTONE LN, MATTOON, IL 61938-6105
(217) 235-5881
(217) 235-5878
Mailing address
1920 BROOKSTONE LN, MATTOON, IL 61938-6105
(217) 235-5881
(217) 235-5878
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
IL
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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