NPI 1013113687

Vandalia Estates, LLC

Organisation Point of Service Vandalia, IL

Practice location

Address: 1607 W Fillmore St, Vandalia, IL 62471-3112
Phone: (618) 283-9825
Fax: (618) 283-9926
Mailing address: 78 Centennial Loop, Eugene, OR 97401-7900

Authorised official

Name: John Holtz
Title: Controller
Phone: (541) 747-3373

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X

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Registry record

NPI: 1013113687
Entity type: Organization
NPI issued: 21 Jun 2007
Record last updated: 14 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.