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General NPI Number Information
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NPI Number | 1548439482
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Entity Type | Organization
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Legal Business Name | TURNER MANOR, INC.
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 901 OGLESBY ST
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City | HARRISBURG
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State | IL
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Zip | 62946-3439
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Country | US
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Telephone | 618-252-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 901 OGLESBY ST P.O. BOX 303
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City | HARRISBURG
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State | IL
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Zip | 62946-3439
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Country | US
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Telephone | 618-252-1215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GRANT CAPE
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Credential |
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Telephone | 618-252-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 0037184
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License Number State | IL
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