MEDICARE: PARKVIEW TERRACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0045294	IL

General Provider Information

NPI Number	:	1487652814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKVIEW TERRACE LLC

Provider Business Mailing Address
First Line	:	430 30TH AVE
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-3152
Country	:	US
Telephone Number	:	309-755-3466
Fax Number	:	309-755-9144

Provider Business Practice Location Address
First Line	:	430 30TH AVE
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-3152
Country	:	US
Telephone Number	:	309-755-3466
Fax Number	:	309-755-9144

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SUZANNE KOENIG
Credential	:
Telephone Number	:	773-202-0000

Provider Enumeration Date	:	07/10/2005
Last Update Date	:	08/22/2020

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Directions to “PARKVIEW TERRACE LLC ” Practice Location

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