Organization
CHAMPAIGN COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN L NOFFKE RN (ADMINISTRATOR)
(217) 693-5015
Entity
Organization
Contact information
Practice address
500 SOUTH ART BARTELL ROAD, URBANA, IL 61802
(217) 384-3874
(217) 337-0120
Mailing address
500 SOUTH ART BARTELL ROAD, URBANA, IL 61802
(217) 384-3784
(217) 337-0120
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0001636
IL
314000000X
Skilled Nursing Facility
Primary
0001636
IL
332BN1400X
Nursing Facility Supplies (DME)
001636
IL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
001636
IL
Other
Enumeration date
07/11/2005
Last updated
03/04/2013
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