Provider Demographics
NPI:1861488090
Name:N & R OF VIENNA, LLC
Entity Type:Organization
Organization Name:N & R OF VIENNA, LLC
Other - Org Name:HILLVIEW HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-658-2951
Mailing Address - Street 1:512 11TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1522
Mailing Address - Country:US
Mailing Address - Phone:618-658-2951
Mailing Address - Fax:618-658-6404
Practice Address - Street 1:512 11TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1522
Practice Address - Country:US
Practice Address - Phone:618-658-2951
Practice Address - Fax:618-658-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32131100OtherSTATE ID
IL954715603002Medicaid
IL954715603002Medicaid