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NPI Code Detail

MEDICARE: CLARK-LINDSEY VILLAGE INC.

MEDICARE: CLARK-LINDSEY VILLAGE 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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1033565882
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARK-LINDSEY VILLAGE INC.
Provider Business Mailing Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-344-2144
Fax Number : 217-344-9147
Provider Business Practice Location Address
First Line : 101 W WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-6663
Country : US
Telephone Number : 217-344-2144
Fax Number : 217-344-9147
Authorized Official
Title or Position : CEO/PRESIDENT
Name : DEBRA REARDANZ
Credential : ADMINISTRATOR
Telephone Number : 217-344-2144
Provider Enumeration Date : 05/11/2016
Last Update Date : 04/24/2017

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Directions to “CLARK-LINDSEY VILLAGE INC. ” Practice Location

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