Organization Name: | CLARK-LINDSEY VILLAGE |
NPI Number: | 1033565882 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBRA REARDANZ (CEO/PRESIDENT) |
Mailing Address: | 101 W Windsor Rd Urbana |
State: | IL US |
Postal Code: | 618026663 |
Phone Number: | 2173442144 |
Fax Number: | 2173449147 |
NPI Enumeration Date: | 05/11/2016 |
NPI Last Update Date: | 05/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |