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General NPI Number Information
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NPI Number | 1568655801
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Entity Type | Organization
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Legal Business Name | WOOD RIVER RETIREMENT CENTER, INC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 395 E EDWARDSVILLE RD
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City | WOOD RIVER
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State | IL
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Zip | 62095-1600
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Country | US
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Telephone | 618-259-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 11701 BORMAN DR STE 315
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4194
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Country | US
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Telephone | 314-994-9070
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | CHUCK SCHMITZ
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Credential |
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Telephone | 314-994-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 9999999
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License Number State | IL
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