MEDICARE: GOLDEN MOMENTS SENIOR CARE CENTER LTD

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	0036848	IL

General Provider Information

NPI Number	:	1467450866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN MOMENTS SENIOR CARE CENTER LTD

Provider Business Mailing Address
First Line	:	1021 N CHURCH ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1301
Country	:	US
Telephone Number	:	217-245-4174
Fax Number	:	217-243-5901

Provider Business Practice Location Address
First Line	:	1021 N CHURCH ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1301
Country	:	US
Telephone Number	:	217-245-4174
Fax Number	:	217-243-5901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MELVIN SIEGEL
Credential	:
Telephone Number	:	847-679-0100

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/06/2007

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