Provider Demographics
NPI:1720073414
Name:MAPLE LAWN HEALTH CENTER
Entity Type:Organization
Organization Name:MAPLE LAWN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-467-9059
Mailing Address - Street 1:700 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1085
Mailing Address - Country:US
Mailing Address - Phone:309-467-2337
Mailing Address - Fax:309-467-9011
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1085
Practice Address - Country:US
Practice Address - Phone:309-467-2337
Practice Address - Fax:309-467-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1694647314000000X
IL0042424314000000X
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0042424Medicaid
IL145431Medicare PIN
IL145431Medicare UPIN
IL145431Medicare Oscar/Certification