Organization
PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
Active
Parent organization
PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
Authorized official
JOELLEN BLEAVINS (VICE PRESIDENT OF MANAGEMENT AGENT)
(815) 935-1992
Entity
Organization
Contact information
Practice address
200 INTERNATIONAL DRIVE, RANTOUL, IL 61866
(217) 892-2800
(217) 892-2833
Mailing address
200 INTERNATIONAL DRIVE, RANTOUL, IL 61866
(217) 892-2800
(217) 892-2833
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Enumeration date
10/22/2015
Last updated
11/03/2015
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