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General NPI Number Information
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NPI Number | 1063505006
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Entity Type | Organization
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Legal Business Name | COUNTY OF WILL
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 421 DORIS AVE
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City | JOLIET
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State | IL
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Zip | 60433-2569
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Country | US
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Telephone | 815-727-8710
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Fax | 815-727-8637
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Provider Business Mailing Address
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Address Line | 421 DORIS AVE
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City | JOLIET
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State | IL
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Zip | 60433-2569
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Country | US
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Telephone | 815-727-8710
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Fax | 815-727-8637
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KAREN SORBERO
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Credential | LNHA
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Telephone | 815-727-8650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0014076
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License Number State | IL
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