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NPI Code Detail

MEDICARE: NORTH LOGAN HEALTHCARE

MEDICARE: NORTH LOGAN HEALTHCARE
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
1314000000XSkilled Nursing Facility0046532IL

General Provider Information

NPI Number : 1275764466
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH LOGAN HEALTHCARE
Provider Business Mailing Address
First Line : 801 N LOGAN AVE
Second Line :
City : DANVILLE
State : IL
Zip : 61832-3715
Country : US
Telephone Number : 217-443-3106
Fax Number : 217-443-3184
Provider Business Practice Location Address
First Line : 801 N LOGAN AVE
Second Line :
City : DANVILLE
State : IL
Zip : 61832-3715
Country : US
Telephone Number : 217-443-3106
Fax Number : 217-443-3187
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. CLAIRE JANE MATHENY
Credential : ADMINISTATOR
Telephone Number : 217-443-3106
Provider Enumeration Date : 08/05/2009
Last Update Date : 08/05/2009

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1558617357 — KATHLEEN PRATHER
Practice Location Address:
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Practice Location Address:
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Directions to “NORTH LOGAN HEALTHCARE ” Practice Location

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