Basic Information
| Provider Information | |||||||||
| NPI: | 1114915410 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DSI PARTNERS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LYNNCREST MANOR OF PARIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 S EADS AVE | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619441938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174655395 | ||||||||
| FaxNumber: | 2174637905 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 S EADS AVE | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619441938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174655395 | ||||||||
| FaxNumber: | 2174637905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 10/11/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2174655395 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1615469 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.