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Contact Information

LAKEWOOD SENIOR LIVING OF MATTOON
2121 S 9TH ST
MATTOON, IL61938
 Phone: 217-235-7138
 Fax: 217-235-7140
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for LAKEWOOD SENIOR LIVING OF MATTOON

NPI Number 1447284245
LBN Legal business name LAKEWOOD SENIOR LIVING OF MATTOON
Authorized official RICHARD BROCKMAN - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 07/10/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
IL License # 0041574
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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