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General NPI Number Information
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NPI Number | 1881734416
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Entity Type | Organization
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Legal Business Name | COUNTY OF RANDOLPH NURSING HOME
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 312 W BELMONT ST
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City | SPARTA
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State | IL
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Zip | 62286-1709
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Country | US
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Telephone | 618-443-4351
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Fax | 618-443-2700
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Provider Business Mailing Address
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Address Line | 312 W BELMONT ST P.O. BOX 358
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City | SPARTA
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State | IL
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Zip | 62286-1709
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Country | US
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Telephone | 618-443-4351
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Fax | 618-443-2700
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LIZ DILDAY
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Credential |
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Telephone | 618-443-4351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0000497
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License Number State | IL
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