Provider Demographics
NPI:1225339468
Name:APOSTOLIC CHRISTIAN HOME FOR THE HANDICAPPED
Entity Type:Organization
Organization Name:APOSTOLIC CHRISTIAN HOME FOR THE HANDICAPPED
Other - Org Name:OAKWOOD ESTATE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-266-9781
Mailing Address - Street 1:2213 VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9567
Mailing Address - Country:US
Mailing Address - Phone:309-266-9781
Mailing Address - Fax:309-266-9468
Practice Address - Street 1:2213 VETERANS RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-9567
Practice Address - Country:US
Practice Address - Phone:309-266-9781
Practice Address - Fax:309-266-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0033712315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid