Provider Demographics
NPI:1528206927
Name:CAMBRIDGE HOUSE OF SWANSEA
Entity Type:Organization
Organization Name:CAMBRIDGE HOUSE OF SWANSEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHANNON-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-234-8910
Mailing Address - Street 1:3900 SULLIVAN DR.
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-234-8910
Mailing Address - Fax:618-234-8920
Practice Address - Street 1:3900 SULLIVAN DR.
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-234-8910
Practice Address - Fax:618-234-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility