Healthcare Provider Details

I. General information

NPI: 1023006848
Provider Name (Legal Business Name): TIMBER POINT HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E SPRING ST
CAMP POINT IL
62320-1307
US

IV. Provider business mailing address

2201 MAIN ST
EVANSTON IL
60202-1519
US

V. Phone/Fax

Practice location:
  • Phone: 217-593-7734
  • Fax: 217-593-6360
Mailing address:
  • Phone: 847-905-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0043158
License Number StateIL

VIII. Authorized Official

Name: MRS. JENNIE SHAN-MARTIN
Title or Position: CONTROLLER
Credential:
Phone: 847-905-4026