Adeline E. Prouty Trust

NPI 1013124593 - Assisted Living Facility - 310400000X

NPI Details
NPI 1013124593
Enumeration Date 05/16/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name PHILLIP KARL PHILLIP
Position ADMINISTRATOR
Phone (815) 872-2261
Fax (815) 875-1758
Practice Location
508 PARK AVE E
PRINCETON IL, 61356-2538, US
Phone (815) 872-2261
Fax (815) 875-1758
Business Location
508 PARK AVE E
PRINCETON IL, 61356-2538, US
Phone (815) 872-2261
Fax (815) 875-1758
Toxanomy
Taxonomy Code 310400000X
License State Illinois
License Number 0021956
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According to our database, Adeline E. Prouty Trust NPI is 1013124593, taxonomy code is 310400000X and license number is 0021956, license state is located at Illinois. Adeline E. Prouty Trust physically located at 508 Park Ave E, Princeton IL, 61356-2538. NPI Number 1033115704 has the healthcare provider type.

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1013124593 NPI number is provided on an as is basis without warranty of any kind. 1013124593 is maintained by the National Plan & Provider Enumeration System. The contents of Adeline E. Prouty Trust are for informational purposes only.