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General NPI Number Information
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NPI Number | 1851997712
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Entity Type | Organization
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Legal Business Name | WP-ARC CHATHAM HOLDINGS, LLC
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 825 E WALNUT ST
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City | CHATHAM
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State | IL
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Zip | 62629-1737
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Country | US
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Telephone | 217-483-4661
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Fax | 217-483-4662
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Provider Business Mailing Address
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Address Line | 825 E WALNUT ST
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City | CHATHAM
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State | IL
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Zip | 62629-1737
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Country | US
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Telephone | 217-483-4661
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Fax | 217-483-4662
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Authorized Official
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Title or Position | REIMBURSEMENT ANALYST
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Name | MR. HENRY JAMES VAUGHN
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Credential |
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Telephone | 240-595-6025
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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 |
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