Organization
FRIENDSHIP MANOR INVESTORS LLC
Active
Other names
FRIENDSHIP MANOR HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK IDE (PRESIDENT)
(317) 670-1577
Entity
Organization
Contact information
Practice address
485 S FRIENDSHIP DR, NASHVILLE, IL 62263-1363
(618) 327-3041
(618) 327-4001
Mailing address
485 S FRIENDSHIP DR, NASHVILLE, IL 62263-1363
(618) 327-3041
(618) 327-4001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0045922
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
371302197001
MDS MEDICAID NUMBER
IL
01
—
704
BC BS OF ILLINOIS
IL
Enumeration date
10/20/2005
Last updated
04/20/2008
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