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MISS HOLLY SUZANNE MOORE MSOTR/L

>> Skilled Nursing Facility >> Nursing & Custodial Care Facilities

Registrant NPI Number: 1255648390

Individual Registrant:
MISS HOLLY SUZANNE MOORE MSOTR/L
Gender: F
Sole Proprietor

Location and contact information for practice:
202 WEST DAVENPORT STREET  CROSSVILLE, IL 62827 US
Tel: 618-928-4801  Fax: --

Contact information for business:
202 WEST DAVENPORT STREET  CROSSVILLE, IL 62827 US
Tel: 618-928-4801  Fax: --

Registration Information:
NPI: 1255648390
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y314000000XNursing & Custodial Care Facilities
Skilled Nursing Facility
IL056.008560
N314000000XNursing & Custodial Care Facilities
Skilled Nursing Facility
IN31004566A

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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