Provider Demographics
NPI:1154573467
Name:KLEEMAN VILLAGE
Entity type:Organization
Organization Name:KLEEMAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-935-9496
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-0616
Mailing Address - Country:US
Mailing Address - Phone:217-935-6655
Mailing Address - Fax:217-935-5305
Practice Address - Street 1:1101 KLEEMANN DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-9465
Practice Address - Country:US
Practice Address - Phone:217-935-6655
Practice Address - Fax:217-935-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness