WC- Mattoon North Ops, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WC- MATTOON NORTH OPS, LLC

Practice address

1920 Brookstone LN
Mattoon, IL 61938-6105

Phone

(217) 235-5881

Fax

(217) 235-5878

NPI assigned

Jan 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Russell

Title

Executive Director

Phone

(217) 235-5881

Specialties & licenses 1

Addresses

Other names 1

• Brookstone Of Mattoon North Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1265820526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 BROOKSTONE LN",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619386105",
            "telephone_number": "217-235-5881",
            "fax_number": "217-235-5878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 BROOKSTONE LN",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619386105",
            "telephone_number": "217-235-5881",
            "fax_number": "217-235-5878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WC- MATTOON NORTH OPS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "217-235-5881",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookstone Of Mattoon North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ali Hassan Ali Warda, MD
• Sandra Warner
• Megan Lynn Wascher, PA-C
• Kallee Washburn, B.A.
• Ana Lidia Werner Watts, MD
• Allison Weber, DPT
• Brent M Weber, MD
• Brandon Wells, RSA
• Mikayla L Welsh, CCC-SLP
• Laura Welton

• Assisted Living Facility in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.