Provider Demographics
NPI:1558354472
Name:UNITED METHODIST VILLAGE INC
Entity Type:Organization
Organization Name:UNITED METHODIST VILLAGE INC
Other - Org Name:UNITED METHODIST VILLAGE, THE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAWKINS-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-943-3347
Mailing Address - Street 1:1616 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2154
Mailing Address - Country:US
Mailing Address - Phone:618-943-3347
Mailing Address - Fax:618-943-3823
Practice Address - Street 1:1616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2154
Practice Address - Country:US
Practice Address - Phone:618-943-3347
Practice Address - Fax:618-943-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0014506313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
145417Medicare Oscar/Certification