Provider Demographics
NPI:1578766242
Name:ORDER OF THE EASTERN STAR HOME
Entity Type:Organization
Organization Name:ORDER OF THE EASTERN STAR HOME
Other - Org Name:EASTERN STAR HOME OF MACON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN LNHA
Authorized Official - Phone:217-764-3348
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:IL
Mailing Address - Zip Code:62544
Mailing Address - Country:US
Mailing Address - Phone:217-774-9620
Mailing Address - Fax:217-764-3472
Practice Address - Street 1:9890 STAR LANE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:IL
Practice Address - Zip Code:62544
Practice Address - Country:US
Practice Address - Phone:217-764-3348
Practice Address - Fax:217-764-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1758783313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility