Healthcare Provider Details

I. General information

NPI: 1275550105
Provider Name (Legal Business Name): STERLING SNF MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 WEST ST MARYS STREET
STERLING IL
61081-9040
US

IV. Provider business mailing address

PO BOX 1667
HICKORY NC
28603-1667
US

V. Phone/Fax

Practice location:
  • Phone: 815-626-9020
  • Fax: 815-626-6434
Mailing address:
  • Phone: 828-324-8898
  • Fax: 828-322-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0050476
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN D WOMACK
Title or Position: MANAGING MEMBER
Credential:
Phone: 828-381-5360