Healthcare Provider Details

I. General information

NPI: 1407801293
Provider Name (Legal Business Name): APOSTOLIC CHRISTIAN RESTMOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARKSIDE AVE
MORTON IL
61550
US

IV. Provider business mailing address

1500 PARKSIDE AVE
MORTON IL
61550-2629
US

V. Phone/Fax

Practice location:
  • Phone: 309-284-1400
  • Fax: 309-266-7877
Mailing address:
  • Phone: 309-284-1400
  • Fax: 309-266-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0023952
License Number StateIL

VIII. Authorized Official

Name: AMY L RODGERS
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 309-284-1412