LILLY E HAVERSTOCK Nursing Home Administrator License verification

Business Entity

INACTIVE

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044004981

License Status

INACTIVE

Business

First Name

LILLY E

Last Name

HAVERSTOCK

Business Name

LILLY E HAVERSTOCK

Original Issue Date

09/21/1995

Effective Date

11/01/2011

Expiration Date

11/30/2013

City

ALLENVILLE

State

Zip

61951

County

MOULTRIE

Ever Disciplined

LastModifiedDate

09/05/2013