Provider Demographics
NPI:1346315165
Name:WESTMINSTER VILLAGE INC
Entity Type:Organization
Organization Name:WESTMINSTER VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:309-663-6474
Mailing Address - Street 1:2025 EAST LINCOLN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5995
Mailing Address - Country:US
Mailing Address - Phone:309-663-6474
Mailing Address - Fax:309-661-2749
Practice Address - Street 1:2025 E. LINCOLN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5995
Practice Address - Country:US
Practice Address - Phone:309-663-6474
Practice Address - Fax:309-661-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164606314000000X
IL0028191314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0028191OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH
145400Medicare Oscar/Certification