NPI 1508086810

Penta Nascent Corporation

Organisation Intellectual Disabilities Intermediate Care Facility Centralia, IL

Practice location

Address: 332 Country Club Rd, Centralia, IL 62801-3742
Phone: (618) 533-7922
Mailing address: PO Box 1690, Centralia, IL 62801-9124

Authorised official

Name: Georgia Miller
Title: Ceo
Phone: (618) 548-4561

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 0038646 (IL)

Other Intermediate Care Facility, Intellectual Disabilities providers in Illinois →

Registry record

NPI: 1508086810
Entity type: Organization
NPI issued: 27 Apr 2007
Record last updated: 22 Aug 2020

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.