Provider Demographics
NPI:1467450866
Name:GOLDEN MOMENTS SENIOR CARE CENTER LTD
Entity Type:Organization
Organization Name:GOLDEN MOMENTS SENIOR CARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-0100
Mailing Address - Street 1:1021 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1301
Mailing Address - Country:US
Mailing Address - Phone:217-245-4174
Mailing Address - Fax:217-243-5901
Practice Address - Street 1:1021 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1301
Practice Address - Country:US
Practice Address - Phone:217-245-4174
Practice Address - Fax:217-243-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036848314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145928Medicare ID - Type Unspecified