Provider Demographics
NPI:1417028168
Name:GENERAL BAPTIST NURSING HOME OF ILLINOIS
Entity Type:Organization
Organization Name:GENERAL BAPTIST NURSING HOME OF ILLINOIS
Other - Org Name:OAKVIEW HEIGHTS CONT. CARE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-1020
Mailing Address - Street 1:1320 W. 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:MT. CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863
Mailing Address - Country:US
Mailing Address - Phone:618-263-4337
Mailing Address - Fax:618-262-7080
Practice Address - Street 1:1320 W. 9TH STREET
Practice Address - Street 2:
Practice Address - City:MT. CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863
Practice Address - Country:US
Practice Address - Phone:618-263-4337
Practice Address - Fax:618-262-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0026328314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0026328Medicaid
IL371104053628Medicaid
IL371104053628Medicaid