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General NPI Number Information
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NPI Number | 1457476632
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Entity Type | Organization
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Legal Business Name | PINCKNEYVILLE HEALTHCARE CENTER LLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708 VIRGINIA COURT
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City | CENTRALIA
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State | IL
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Zip | 62801
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Country | US
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Telephone | 618-357-2493
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Fax | 618-357-3120
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Provider Business Mailing Address
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Address Line | 708 VIRGINIA CT
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1538
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Country | US
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Telephone | 618-357-2493
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Fax | 618-357-3120
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS GARY DEAN ALBERT
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Credential |
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Telephone | 618-357-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | IL
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