Provider Demographics
NPI:1871646133
Name:PARIS HEALTH CARE CENTER INVESTORS LLC
Entity Type:Organization
Organization Name:PARIS HEALTH CARE CENTER INVESTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-557-1190
Mailing Address - Street 1:1011 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1145
Mailing Address - Country:US
Mailing Address - Phone:217-465-5376
Mailing Address - Fax:217-465-8106
Practice Address - Street 1:1011 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1145
Practice Address - Country:US
Practice Address - Phone:217-465-5376
Practice Address - Fax:217-465-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046565314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3833592165001Medicaid
IL830362033001Medicaid
145469Medicare Oscar/Certification