Organization
CEP AMERICA - ILLINOIS SNF, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE KOURY MD (ADMINISTRATIVE VP OF OPERATIONS)
(510) 350-2600
Entity
Organization
Contact information
Practice address
1021 W E ST, BELLEVILLE, IL 62220-1055
(618) 233-2095
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1826
(510) 350-2600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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