Provider Demographics
NPI:1902294267
Name:WC- TUSCOLA OPS, LLC
Entity Type:Organization
Organization Name:WC- TUSCOLA OPS, LLC
Other - Org Name:BROOKSTONE ESTATES TUSCOLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-253-6300
Mailing Address - Street 1:1106 E NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-7836
Mailing Address - Country:US
Mailing Address - Phone:217-253-6300
Mailing Address - Fax:217-253-9710
Practice Address - Street 1:1106 E NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-7836
Practice Address - Country:US
Practice Address - Phone:217-253-6300
Practice Address - Fax:217-253-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility