Provider Demographics
NPI:1275764466
Name:NORTH LOGAN HEALTHCARE
Entity Type:Organization
Organization Name:NORTH LOGAN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTATOR
Authorized Official - Phone:217-443-3106
Mailing Address - Street 1:801 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3715
Mailing Address - Country:US
Mailing Address - Phone:217-443-3106
Mailing Address - Fax:217-443-3184
Practice Address - Street 1:801 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3715
Practice Address - Country:US
Practice Address - Phone:217-443-3106
Practice Address - Fax:217-443-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046532314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility