Basic Information
| Provider Information | |||||||||
| NPI: | 1285735878 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURGIN MANOR OF OLNEY INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624502576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183951000 | ||||||||
| FaxNumber: | 6183922150 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624502576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183951000 | ||||||||
| FaxNumber: | 6183922150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | BURGIN | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6183951000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0026765 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.