NPI 1053708057
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Practice location
- Address
- 3001 Save Rd, Belleville, IL 62221-7018
- Phone
- (618) 234-1992
- Mailing address
- 114 S Market St, Mascoutah, IL 62258-2432
Authorised official
- Name
- Randy Law
- Title
- Executive Administrator
- Phone
- (618) 234-1992
Registered specialties
Nursing Care Agency
Primary
Registry record
- NPI
- 1053708057
- Entity type
- Organization
- NPI issued
- 17 Apr 2015
- Record last updated
- 17 Apr 2015
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.