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Organization

COVENANT CARE OF O'FALLON, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY POTTS (PRESIDENT)
(618) 632-3511
Entity
Organization

Contact information

Practice address
700 WEBER RD, O FALLON, IL 62269-2248
(618) 632-3511
(618) 632-3053
Mailing address
700 WEBER RD, O FALLON, IL 62269-2248
(618) 632-3511
(618) 632-3053

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1733880
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1733880
IL
Enumeration date
08/21/2006
Last updated
02/28/2008
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