Healthcare Provider Details

I. General information

NPI: 1821531682
Provider Name (Legal Business Name): ALTON NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 HUMBERT RD
ALTON IL
62002-7101
US

IV. Provider business mailing address

3490 HUMBERT RD
ALTON IL
62002-7101
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-2626
  • Fax: 618-465-4473
Mailing address:
  • Phone: 618-465-2626
  • Fax: 618-465-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES MASON
Title or Position: PRESIDENT
Credential:
Phone: 813-347-7425