Provider Demographics
NPI:1497999213
Name:GENERAL BAPTIST NURSING HOME, INC.
Entity Type:Organization
Organization Name:GENERAL BAPTIST NURSING HOME, INC.
Other - Org Name:OAKVIEW VILLA SUPPORTIVE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-263-4092
Mailing Address - Street 1:916 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2455
Mailing Address - Country:US
Mailing Address - Phone:618-263-4094
Mailing Address - Fax:
Practice Address - Street 1:916 OAK ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2455
Practice Address - Country:US
Practice Address - Phone:618-263-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility