Organization
PRAIRIE VILLAGE HEALTHCARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE SHANMARTIN CONTROLLER (MEDICARE BILLING)
(847) 905-4026
Entity
Organization
Contact information
Practice address
1024 W WALNUT ST, JACKSONVILLE, IL 62650-1251
(217) 245-5175
(217) 243-4276
Mailing address
2201 MAIN ST, EVANSTON, IL 60202-1519
(847) 905-4000
(847) 905-4040
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0042671
IL
Other
Enumeration date
02/21/2007
Last updated
02/09/2010
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