Organization
BRIDGEMARK OF GREENVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN P MILLER (MEMBER)
(312) 994-2306
Entity
Organization
Contact information
Practice address
400 E HILLVIEW AVE, GREENVILLE, IL 62246-2607
(618) 664-1622
Mailing address
400 E HILLVIEW AVE, GREENVILLE, IL 62246-2607
(618) 664-1622
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0046680
IL
314000000X
Skilled Nursing Facility
Primary
0046680
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046680
FACILITY LICENSE NUMBER
IL
Enumeration date
07/07/2005
Last updated
04/29/2015
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