Healthcare Provider Details

I. General information

NPI: 1487804100
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 07/21/2022
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GALEENER ST
VIENNA IL
62995-1676
US

IV. Provider business mailing address

1000 GALEENER ST
VIENNA IL
62995-1676
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-2775
  • Fax:
Mailing address:
  • Phone: 618-658-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number015
License Number StateIL

VIII. Authorized Official

Name: LAURA K COWSER
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 618-652-2046