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Active
Organization subpart
No

Provider details

NPI number
Authorized official
RACHEL LEA STEWARD (BUSINESS OFFICE MANAGER)
(217) 854-9606
Entity
Organization

Contact information

Practice address
826 N HIGH ST, CARLINVILLE, IL 62626-1165
(217) 854-9606
(217) 854-8126
Mailing address
826 N HIGH ST, CARLINVILLE, IL 62626-1165
(217) 854-9606
(217) 854-8126

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0042846
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1558358804
MEDICARE A & B
IL
Enumeration date
03/25/2016
Last updated
03/25/2016
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