WC- MATTOON NORTH OPS LLC NPI 1265820526

NPI Information

  • NPI: 1265820526
  • Provider Name: WC- MATTOON NORTH OPS, LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: BROOKSTONE OF MATTOON NORTH
  • CLIA Number: 14D2195527
  • Address: 1920 BROOKSTONE LN
    MATTOON, IL
    ZIP 61938
  • Phone: (217) 235-5881

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NPI Details

WC- MATTOON NORTH OPS, LLC is an assisted living facility in Mattoon, IL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. WC- MATTOON NORTH OPS, LLC NPI is 1265820526. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookstone Of Mattoon North.

The provider's business location address is:

1920 BROOKSTONE LN
MATTOON, IL
ZIP 61938-105
Phone: (217) 235-5881
Fax: (217) 235-5878

The provider's authorized official is Robert Russell .
The authorized official title is Executive Director and has the following contact phone number (217) 235-5881.

The CLIA number assigned to this NPI record is 14D2195527 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/8/2015 and was last updated on 1/8/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityILLINOISYes

What is NPI?

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This page was last updated on: 11/21/2025

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