Provider Demographics
NPI:1932304789
Name:CAMBRIDGE HOUSE OF OFALLON
Entity Type:Organization
Organization Name:CAMBRIDGE HOUSE OF OFALLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:618-624-9900
Mailing Address - Street 1:844 CAMBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1976
Mailing Address - Country:US
Mailing Address - Phone:618-624-9900
Mailing Address - Fax:618-624-9904
Practice Address - Street 1:844 CAMBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1976
Practice Address - Country:US
Practice Address - Phone:618-624-9900
Practice Address - Fax:618-624-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility