MEDICARE: TIMBER POINT HEALTHCARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0043158	IL

General Provider Information

NPI Number	:	1023006848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBER POINT HEALTHCARE CENTER INC

Provider Business Mailing Address
First Line	:	2201 MAIN ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1519
Country	:	US
Telephone Number	:	847-905-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E SPRING ST
Second Line	:
City	:	CAMP POINT
State	:	IL
Zip	:	62320-1307
Country	:	US
Telephone Number	:	217-593-7734
Fax Number	:	217-593-6360

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. JENNIE SHAN-MARTIN
Credential	:
Telephone Number	:	847-905-4026

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/06/2010

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