Mattoon Estates South, LLC

NPI #1518163187 in Mattoon, Illinois

Provider Information

NPI Number
1518163187
Entity Type
Organization
Organization Name
Mattoon Estates South, LLC
Primary Specialty
Point of Service
Enumeration Date
Jun 21, 2007
Last Updated
May 14, 2008

Practice Location

Address
2008 S 9TH ST
ZIP Code
61938-6164
Phone
(217) 235-5871

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Point of Service

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