Healthcare Provider Details

I. General information

NPI: 1144794207
Provider Name (Legal Business Name): PARADOX CHAMPAIGN OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E SPRINGFIELD AVE
CHAMPAIGN IL
61820-5405
US

IV. Provider business mailing address

309 E SPRINGFIELD AVE
CHAMPAIGN IL
61820-5405
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-5135
  • Fax:
Mailing address:
  • Phone: 217-352-5135
  • Fax:

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: WILLIAM ROTHNER
Title or Position: MANAGER LLC
Credential:
Phone: 847-905-4000