Fireside-Ltc, LLC
NPI #1346526134 in Centralia, Illinois
Provider Information
- NPI Number
- 1346526134
- Entity Type
- Organization
- Organization Name
- Fireside-Ltc, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Oct 25, 2011
- Last Updated
- Nov 10, 2011
Practice Location
Authorized Official
- Name
- MR. DAREN G DOUSTON
- Title
- MEMBER CFO
- Phone
- (678) 522-2436
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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