Evenglow Lodge in Pontiac - Skilled Nursing Facility
Evenglow Lodge - NPI 1558314302
Evenglow Lodge is a Skilled Nursing Facility in Pontiac, Illinois. Evenglow Lodge practices all healthcare services and medical treatments related to Skilled Nursing Facility. The NPI Number for Evenglow Lodge is 1558314302. The last update date is 2008-04-17.
Evenglow Lodge's current location address is 215 E Washington St, Pontiac, Illinois. You can contact this provider via phone number 8158446131 and fax number 8158423558. The mailing address for Evenglow Lodge is 215 E Washington St, Pontiac, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Evenglow Lodge |
|---|---|
| Address | 215 E Washington St, Pontiac, Illinois |
| Phone Number | 8158446131 |
| Fax Number | 8158423558 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Hovren Mark |
| Telephone Number | 8158446131 |
NPI Number Detail
| NPI Number | 1558314302 |
|---|---|
| Provider Enumeration Date | 2006-05-19 |
| Last Updated Date | 2008-04-17 |
Provider Mailing Address Detail
| Address | 215 E Washington St |
|---|---|
| City | Pontiac |
| State | Illinois (IL) |
| Post Code | 617642011 |
| Phone Number | 8158446131 |
| Fax Number | 8158423558 |
Provider's Primary Taxonomy Detail
| Speciality | Skilled Nursing Facility |
|---|---|
| Taxonomy | 314000000X |
| Licence No | 8425 |
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Definition: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring serv |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 146095 | IL | -- |
Post Comment/ Review Below
What is the unique 10-digit identifier code issued to Evenglow Lodge by the Centers for Medicare & Medicaid Services?
The Evenglow Lodge has been assigned the NPI (National Provider Identifier) 1558314302 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you please share the complete physical location address where Evenglow Lodge's facilities are situated?
The facilities of Evenglow Lodge are physically located at the following address: 215 E Washington St, Pontiac, IL, 617642011.
What is Evenglow Lodge's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Evenglow Lodge is Skilled Nursing Facility, and the taxonomy code that categorizes this field of expertise is 314000000X.
On what date did the Centers for Medicare & Medicaid Services issue the 1558314302 to Evenglow Lodge?
The Evenglow Lodge received its 1558314302 assignment from the Centers for Medicare & Medicaid Services on 2006-05-19.
As of what date were the details pertaining to Evenglow Lodge last refreshed?
The information related to the Evenglow Lodge, including its address, specialty, and other relevant details, was last updated on 2008-04-17.
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