Provider Demographics
NPI:1750313813
Name:TWIN WILLOWS NURSING CENTER INC
Entity Type:Organization
Organization Name:TWIN WILLOWS NURSING CENTER INC
Other - Org Name:TWIN WILLOWS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-0542
Mailing Address - Street 1:1600 NORTH BROADWAY
Mailing Address - Street 2:PO BOX 370 TWIN WILLOWS NURSING CENTER
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0370
Mailing Address - Country:US
Mailing Address - Phone:618-548-0542
Mailing Address - Fax:618-548-3081
Practice Address - Street 1:1600 NORTH BROADWAY
Practice Address - Street 2:TWIN WILLOWS NURSING CENTER
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-0370
Practice Address - Country:US
Practice Address - Phone:618-548-0542
Practice Address - Fax:618-548-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0014753314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14E645Medicaid
IL0014753OtherILLINOIS PUBLIC HEALTH
IL14E645Medicaid