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NPI Code Detail

MEDICARE: CLARK-LINDSEY VILLAGE, INC.

MEDICARE: CLARK-LINDSEY VILLAGE, INC.
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
1314000000XSkilled Nursing Facility1674035IL

General Provider Information

NPI Number : 1922003326
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARK-LINDSEY VILLAGE, INC.
Provider Business Mailing Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-344-2144
Fax Number : 217-344-9147
Provider Business Practice Location Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-344-2144
Fax Number : 217-344-9147
Authorized Official
Title or Position : VICE PRESIDENT/CFO
Name : MRS. DEBRA REARDANZ
Credential : C.P.A.
Telephone Number : 217-344-2144
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/22/2020

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Directions to “CLARK-LINDSEY VILLAGE, INC. ” Practice Location

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