Organization
SOUTHERN ILLINOIS LIVING CENTERS INC.
Active
Other names
Clitnon Manor Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ALBERT BRAVE (ADMINISTRATOR)
(618) 588-2066
Entity
Organization
Contact information
Practice address
111 E ILLINOIS ST, NEW BADEN, IL 62265-1850
(618) 588-2066
(618) 588-4673
Mailing address
300 E ILLINOIS ST, NEW BADEN, IL 62265-1822
(618) 588-2066
(618) 588-4673
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0033159
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371224393003
—
IL
Enumeration date
09/15/2010
Last updated
09/15/2010
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