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General NPI Number Information
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NPI Number | 1225256696
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Entity Type | Organization
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Legal Business Name | WOODSTOCK CHRISTIAN LIFE SERVICES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 920 N SEMINARY AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-2996
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Country | US
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Telephone | 815-334-6200
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Fax | 815-338-8846
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Provider Business Mailing Address
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Address Line | 318 CHRISTIAN WAY
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City | WOODSTOCK
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State | IL
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Zip | 60098-2912
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Country | US
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Telephone | 815-334-6200
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Fax | 815-206-0472
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | MATTHEW BOSWELL
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Credential |
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Telephone | 716-338-9766
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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 | 6009310
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License Number State | IL
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