Provider Demographics
NPI:1588836258
Name:UDI 7
Entity Type:Organization
Organization Name:UDI 7
Other - Org Name:SEMINARY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-344-1300
Mailing Address - Street 1:2345 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-344-1300
Mailing Address - Fax:309-344-2473
Practice Address - Street 1:2345 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-344-1300
Practice Address - Fax:309-344-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363114893007Medicaid
5443OtherBLUE CROSS BLUE SHIELD
IL363114893007Medicaid