Organization
ELLEN LISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN LISTING (RN)
(815) 601-4055
Entity
Organization
Contact information
Practice address
14094 KENNEDY DR, SOUTH BELOIT, IL 61080-2502
(815) 601-4055
Mailing address
14094 KENNEDY DR, SOUTH BELOIT, IL 61080-2502
(815) 601-4055
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
108005-030
WI
Other
Enumeration date
03/02/2010
Last updated
03/02/2010
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