Basic Information
| Provider Information | |||||||||
| NPI: | 1346231198 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. CLARA'S MANOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626562619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177351507 | ||||||||
| FaxNumber: | 2177323188 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626562619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177351507 | ||||||||
| FaxNumber: | 2177323188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 06/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | ATER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 3098237135 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0016949 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.