Healthcare Provider Details

I. General information

NPI: 1649268947
Provider Name (Legal Business Name): PALLADIAN TAYLORVILLE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S HOUSTON ST
TAYLORVILLE IL
62568-2073
US

IV. Provider business mailing address

1670 ESSEX WAY STE B
O FALLON IL
62269-3063
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-9636
  • Fax: 217-824-8437
Mailing address:
  • Phone: 618-327-3064
  • Fax: 618-327-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1615453
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL JASON MILLS
Title or Position: CFO
Credential:
Phone: 314-566-0459