Provider Demographics
NPI:1265465652
Name:WALKER NURSING HOME INC
Entity Type:Organization
Organization Name:WALKER NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-452-3218
Mailing Address - Street 1:530 EAST BEARDSTOWN STREET
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691
Mailing Address - Country:US
Mailing Address - Phone:217-452-3218
Mailing Address - Fax:217-452-7746
Practice Address - Street 1:530 EAST BEARDSTOWN STREET
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:IL
Practice Address - Zip Code:62691
Practice Address - Country:US
Practice Address - Phone:217-452-3218
Practice Address - Fax:217-452-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0021428314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14A341Medicaid
IL146100Medicare ID - Type Unspecified