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NPI Code Detail

MEDICARE: SOUTHERN ILLINOIS LIVING CENTERS INC.

MEDICARE: SOUTHERN ILLINOIS LIVING CENTERS 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
1315P00000XIntellectual Disabilities Intermediate Care Facility0033159IL
2314000000XSkilled Nursing Facility0033159IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10033159OTHERILIDPH LICENSE NUMBER

General Provider Information

NPI Number : 1174518278
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN ILLINOIS LIVING CENTERS INC.
Provider Business Mailing Address
First Line : 111 E ILLINOIS ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1850
Country : US
Telephone Number : 618-588-2066
Fax Number : 618-588-4673
Provider Business Practice Location Address
First Line : 111 E ILLINOIS ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1850
Country : US
Telephone Number : 618-588-4924
Fax Number : 618-588-4673
Authorized Official
Title or Position : VICE PRESIDENT ADMINISTRATOR
Name : MR. MICHAEL A BRAVE
Credential : MSW
Telephone Number : 618-588-2066
Provider Enumeration Date : 09/14/2005
Last Update Date : 11/09/2011

Similar Medicare Providers

1972793784 — AMY BOECKMANN PTA
Practice Location Address:
111 E ILLINOIS ST
NEW BADEN, IL
62265-1850
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Practice Fax:
1639487408 — SOUTHERN ILLINOIS LIVING CENTERS INC.
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111 E ILLINOIS ST
NEW BADEN, IL
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Practice Fax: 618-588-4673
1811241516 — MEGAN DEERHAKE OTR/L
Practice Location Address:
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NEW BADEN, IL
62265-1850
Practice Phone: 618-795-6682
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1669143194 — HANNAH ISBELL PTA
Practice Location Address:
111 E ILLINOIS ST
NEW BADEN, IL
62265-1850
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Practice Fax:
1669139614 — JESSA KATE SPRINGER
Practice Location Address:
111 E ILLINOIS ST
NEW BADEN, IL
62265-1850
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Practice Fax:
1962149989 — ZACHARY STEPHEN CARMICHAEL M.S. CF-SLP
Practice Location Address:
111 E ILLINOIS ST
NEW BADEN, IL
62265-1850
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Practice Fax:

Directions to “SOUTHERN ILLINOIS LIVING CENTERS INC. ” Practice Location

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