Healthcare Provider Details

I. General information

NPI: 1881681591
Provider Name (Legal Business Name): ANNA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N MAIN ST
ANNA IL
62906-1622
US

IV. Provider business mailing address

521 N MAIN ST
ANNA IL
62906-1622
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4511
  • Fax: 618-833-2347
Mailing address:
  • Phone: 618-833-4511
  • Fax: 618-833-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TARA PEEK RICHARDSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3672