Ltc of Illinois - Fireside, Inc.
NPI #1700819778 in Centralia, Illinois
Provider Information
- NPI Number
- 1700819778
- Entity Type
- Organization
- Organization Name
- Ltc of Illinois - Fireside, Inc.
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Jul 10, 2006
- Last Updated
- Apr 20, 2008
Practice Location
Authorized Official
- Name
- DOUGLAS K MITTLEIDER
- Title
- PRESIDENT
- Phone
- (770) 619-0866
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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