Organization
EVENGLOW LODGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK HOVREN (PRESIDENT CEO)
(815) 844-6131
Entity
Organization
Contact information
Practice address
215 E WASHINGTON ST, PONTIAC, IL 61764-2011
(815) 844-6131
(815) 842-3558
Mailing address
215 E WASHINGTON ST, PONTIAC, IL 61764-2011
(815) 844-6131
(815) 842-3558
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0008425
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146095
—
IL
Enumeration date
05/19/2006
Last updated
04/17/2008
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