Organization
WILLOWCREEK REHAB AND NURSING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN P MILLER (MEMBER)
(312) 994-2306
Entity
Organization
Contact information
Practice address
40 N 64TH ST, BELLEVILLE, IL 62223-3808
(618) 397-8400
Mailing address
1111 WESTGATE ST, SUITE 110, OAK PARK, IL 60301-1007
(312) 994-2306
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0041939
IL
314000000X
Skilled Nursing Facility
Primary
0041939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041939
FACILITY LICENSE NUMBER
IL
Enumeration date
07/06/2005
Last updated
01/25/2008
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