Healthcare Provider Details

I. General information

NPI: 1790782308
Provider Name (Legal Business Name): LIVING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W IMBODEN DR
DECATUR IL
62521-5238
US

IV. Provider business mailing address

180 W IMBODEN DR
DECATUR IL
62521-5238
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0036574
License Number StateIL

VIII. Authorized Official

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