Healthcare Provider Details

I. General information

NPI: 1437212016
Provider Name (Legal Business Name): NATIONAL ASSISTANCE BUREAU, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTSIDE CARE CENTER 601 NORTH COLUMBIA ST
WEST FRANKFORT IL
62896
US

IV. Provider business mailing address

1145 HEMBREE RD
ROSWELL GA
30076-1122
US

V. Phone/Fax

Practice location:
  • Phone: 618-932-2109
  • Fax: 618-937-1590
Mailing address:
  • Phone: 770-650-8773
  • Fax: 770-650-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0045732
License Number StateIL

VIII. Authorized Official

Name: TYGH BROGDON
Title or Position: MANAGER
Credential:
Phone: 770-650-8773