Evenglow Lodge

LBN: Evenglow Lodge
Evenglow Lodge is an health care organization with primary practice located at 215 E Washington St , Pontiac IL 61764-2011. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Evenglow Lodge can be contacted via phone (815) 844-6131, or through Hovren, Mark via phone (815) 844-6131.

Contact Information

Primary practice address
215 E Washington St Pontiac IL 61764-2011
Phone: (815) 844-6131
Fax: (815) 842-3558
Website:
Map and Directions
Authorized official contact:
Name: Hovren, Mark
Phone: (815) 844-6131

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 0008425 Illinois

Profile Details

NPI number 1558314302
LBN Legal business name Evenglow Lodge
DBA Doing business as
Authorized official Hovren, Mark
Entity Organization
Organization subpart 1 No
Enumeration date May 19th, 2006
Last updated Apr 17th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558314302 NPPES
Illinois MEDICAID 146095

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