Organization
WC- HARRISBURG OPS, LLC
Active
Other names
Brookstone of Harrisburg
Organization subpart
No
Provider details
NPI number
Authorized official
TREVA AUD (EXECUTIVE DIRECTOR)
(618) 253-5870
Entity
Organization
Contact information
Practice address
165 RON MORSE DR, HARRISBURG, IL 62946-5298
(618) 253-5870
(618) 253-5871
Mailing address
165 RON MORSE DR, HARRISBURG, IL 62946-5298
(618) 253-5870
(618) 253-5871
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538557897
—
IL
Enumeration date
01/08/2015
Last updated
06/28/2015
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