Provider Demographics
NPI:1922003326
Name:CLARK-LINDSEY VILLAGE, INC.
Entity type:Organization
Organization Name:CLARK-LINDSEY VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REARDANZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:217-344-2144
Mailing Address - Street 1:101 W WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-6663
Mailing Address - Country:US
Mailing Address - Phone:217-344-2144
Mailing Address - Fax:217-344-9147
Practice Address - Street 1:101 W WINDSOR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6663
Practice Address - Country:US
Practice Address - Phone:217-344-2144
Practice Address - Fax:217-344-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1674035314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145381Medicare ID - Type Unspecified