Organization
COUNTY OF RANDOLPH NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZ DILDAY (ADMINISTRATOR)
(618) 443-4351
Entity
Organization
Contact information
Practice address
312 W BELMONT ST, SPARTA, IL 62286-1709
(618) 443-4351
(618) 443-2700
Mailing address
312 W BELMONT ST, P.O. BOX 358, SPARTA, IL 62286-1709
(618) 443-4351
(618) 443-2700
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0000497
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000497
—
IL
Enumeration date
02/06/2007
Last updated
08/19/2008
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