MEDICARE: IMBODEN CREEK LIVING CENTERS

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1427405075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMBODEN CREEK LIVING CENTERS

Provider Business Mailing Address
First Line	:	180 W IMBODEN DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5238
Country	:	US
Telephone Number	:	217-422-7150
Fax Number	:	217-422-9418

Provider Business Practice Location Address
First Line	:	180 W IMBODEN DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5238
Country	:	US
Telephone Number	:	217-422-7150
Fax Number	:	217-422-9418

Authorized Official
Title or Position	:	MEDICARE BILLER
Name	:	MRS. BEVERLEY KAY BAITY
Credential	:
Telephone Number	:	217-422-7150

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “IMBODEN CREEK LIVING CENTERS ” Practice Location

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