Healthcare Provider Details

I. General information

NPI: 1700877545
Provider Name (Legal Business Name): INDEPENDENT ORDER OF ODD FELLOWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LAFAYETTE AVE E
MATTOON IL
61938-4641
US

IV. Provider business mailing address

201 LAFAYETTE AVE E
MATTOON IL
61938-4641
US

V. Phone/Fax

Practice location:
  • Phone: 217-235-5449
  • Fax: 217-235-0611
Mailing address:
  • Phone: 217-235-5449
  • Fax: 217-235-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0010223
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0010223
License Number StateIL

VIII. Authorized Official

Name: MR. DANIEL L CURRY
Title or Position: EX. VP & CFO
Credential:
Phone: 309-823-7164