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NPI 1609076835

NPI 1609076835 : DSI WATSEKA OPERATOR LLC : WATSEKA, IL

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General NPI Number Information
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    NPI Number           |    1609076835
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    Entity Type          |    Organization 
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    Legal Business Name  |    DSI WATSEKA OPERATOR LLC 
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Dates
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    Enumeration Date     |    07/25/2007
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    Last Update Date     |    07/21/2022
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Provider Practice Location Address
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    Address Line         |    577 E MARTIN AVE 
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    City                 |    WATSEKA
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    State                |    IL
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    Zip                  |    60970-2000
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    Country              |    US
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    Telephone            |    815-432-4560
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    Fax                  |    815-432-4562
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Provider Business Mailing Address
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    Address Line         |    577 E MARTIN AVE 
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    City                 |    WATSEKA
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    State                |    IL
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    Zip                  |    60970-2000
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    Country              |    US
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    Telephone            |    815-432-4560
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    Fax                  |    815-432-4562
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Authorized Official
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    Title or Position    |    ADMINISTRATOR
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    Name                 |    MR. TIMOTHY CHARLES LEADER 
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    Credential           |    RN
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    Telephone            |    815-432-4560
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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       |    
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    License Number State |    IL
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