Healthcare Provider Details

I. General information

NPI: 1104273689
Provider Name (Legal Business Name): NORTH LOGAN HEALTH CARE CENTER INVESTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N LOGAN AVE
DANVILLE IL
61832-3715
US

IV. Provider business mailing address

801 N LOGAN AVE
DANVILLE IL
61832-3715
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-3106
  • Fax: 217-443-3187
Mailing address:
  • Phone: 217-443-3106
  • Fax: 217-443-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JAMMIE ADKINS
Title or Position: REGIONAL DIRECTOR OF A/R
Credential:
Phone: 812-598-2645