Provider Demographics
NPI:1699936054
Name:PINCKNEYVILLE HEALTHCARE CENTER
Entity type:Organization
Organization Name:PINCKNEYVILLE HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:618-357-2493
Mailing Address - Street 1:708 VIRGINIA CT
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1538
Mailing Address - Country:US
Mailing Address - Phone:618-357-2493
Mailing Address - Fax:618-357-9610
Practice Address - Street 1:708 VIRGINIA CT
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1538
Practice Address - Country:US
Practice Address - Phone:618-357-2493
Practice Address - Fax:618-357-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045260313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility