Organization
LAKEWOOD SENIOR LIVING OF MATTOON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS KENT (EXECUTIVE VICE PRESIDENT)
(205) 320-7554
Entity
Organization
Contact information
Practice address
2121 S 9TH ST, MATTOON, IL 61938-6113
(217) 235-7138
Mailing address
3008 7TH AVE S, BIRMINGHAM, AL 35233-3503
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0047860
IL
Other
Enumeration date
11/20/2006
Last updated
08/22/2020
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