Healthcare Provider Details

I. General information

NPI: 1104042993
Provider Name (Legal Business Name): LIVING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 W IMBODEN DR
DECATUR IL
62521-5251
US

IV. Provider business mailing address

180 W IMBODEN DR
DECATUR IL
62521-5238
US

V. Phone/Fax

Practice location:
  • Phone: 217-233-1425
  • Fax: 217-233-1777
Mailing address:
  • Phone: 217-422-7150
  • Fax: 217-422-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: RHONDA S LUTHER
Title or Position: COO
Credential: MA
Phone: 217-422-7150