Organization
PENTA GROUP INC.
Active
Other names
BRYAN MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGIA MILLER (ADMINISTRATOR)
(618) 548-4561
Entity
Organization
Contact information
Practice address
300 SCHOONOVER DRIVE, SALEM, IL 62881
(618) 548-4561
Mailing address
PO BOX 1946, CENTRALIA, IL 62801-9127
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
002
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G0370033373
—
IL
Enumeration date
02/13/2008
Last updated
07/21/2022
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