Organization
SHABBONA SUPPORTIVE LIVING
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
DELORES J NICOLSON (MANAGER)
(815) 824-8480
Entity
Organization
Contact information
Practice address
407 W COMANCHE AVE, SHABBONA, IL 60550-9501
(815) 824-8480
(815) 824-2412
Mailing address
407 W COMANCHE AVE, SHABBONA, IL 60550-9501
(815) 824-8480
(815) 824-2412
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204590974001
—
IL
Enumeration date
09/28/2007
Last updated
04/17/2008
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