Provider Demographics
NPI:1164810420
Name:WC- OLNEY EG OPS, LLC
Entity Type:Organization
Organization Name:WC- OLNEY EG OPS, LLC
Other - Org Name:EMERALD GLEN OLNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-395-4663
Mailing Address - Street 1:1301 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2430
Mailing Address - Country:US
Mailing Address - Phone:618-395-4663
Mailing Address - Fax:618-392-6313
Practice Address - Street 1:1301 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2430
Practice Address - Country:US
Practice Address - Phone:618-395-4663
Practice Address - Fax:618-392-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility