Provider Demographics
NPI:1437668696
Name:MACOMB SENIOR LIVING, LLC
Entity type:Organization
Organization Name:MACOMB SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT OF MANAGEMENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:779-216-5849
Mailing Address - Street 1:200 E COURT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3848
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:815-935-8380
Practice Address - Street 1:1307 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-7508
Practice Address - Country:US
Practice Address - Phone:309-833-5000
Practice Address - Fax:309-833-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility