Organization
GREENWOOD MANOR NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE B PLUMMER DO (OWNER)
(618) 498-6427
Entity
Organization
Contact information
Practice address
410 FLETCHER ST, JERSEYVILLE, IL 62052-2127
(618) 498-6427
(618) 639-3339
Mailing address
410 FLETCHER ST, JERSEYVILLE, IL 62052-2127
(618) 498-6427
(618) 639-3339
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0020206
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I4A111
IL DEPT OF PUBLIC HEALTH
IL
Enumeration date
10/20/2005
Last updated
08/22/2020
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