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General NPI Number Information
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NPI Number | 1508956459
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Entity Type | Organization
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Legal Business Name | CHARLESTON HCO LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 716 18TH ST
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City | CHARLESTON
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State | IL
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Zip | 61920-2382
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Country | US
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Telephone | 217-345-7054
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Fax | 217-348-1264
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Provider Business Mailing Address
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Address Line | 716 18TH ST
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City | CHARLESTON
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State | IL
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Zip | 61920-2382
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Country | US
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Telephone | 217-345-7054
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Fax | 816-276-0150
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Authorized Official
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Title or Position | REVENUE CYCLE COMPLIANCE AUDITOR
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Name | STEPHANIE REDBURN
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Credential |
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Telephone | 816-444-0900
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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 | 0040311
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License Number State | IL
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