Mattoon Estates North, LLC

NPI #1184820748 in Mattoon, Illinois

Provider Information

NPI Number: 1184820748
Entity Type: Organization
Organization Name: Mattoon Estates North, LLC
Primary Specialty: Point of Service
Enumeration Date: Jun 21, 2007
Last Updated: May 13, 2008

Practice Location

Address: 1920 BROOKSTONE LN
City: Mattoon
State: Illinois
ZIP Code: 61938-6105
Phone: (217) 235-5881

Authorized Official

Name: MR. JOHN HOLTZ
Title: CONTROLLER
Phone: (541) 747-3373

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Point of Service	305S00000X	Primary

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