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NPI Code Detail

MEDICARE: CARAVILLA RESIDENTIAL CENTERS, INC

MEDICARE: CARAVILLA RESIDENTIAL 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
1313M00000XNursing Facility/Intermediate Care Facility0039800IL

General Provider Information

NPI Number : 1659363661
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARAVILLA RESIDENTIAL CENTERS, INC
Provider Business Mailing Address
First Line : 5 DOCTORS PARK RD
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6224
Country : US
Telephone Number : 618-242-1064
Fax Number : 618-242-7559
Provider Business Practice Location Address
First Line : 5 DOCTORS PARK RD
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-6224
Country : US
Telephone Number : 618-242-1064
Fax Number : 618-242-7559
Authorized Official
Title or Position : CORPORATE ATTORNEY
Name : MICHAEL F FLANAGAN
Credential :
Telephone Number : 816-444-0900
Provider Enumeration Date : 08/16/2005
Last Update Date : 08/22/2020

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Directions to “CARAVILLA RESIDENTIAL CENTERS, INC ” Practice Location

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