Healthcare Provider Details

I. General information

NPI: 1326105636
Provider Name (Legal Business Name): ILLINOIS VETERANS HOME AT ANNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 N MAIN ST
ANNA IL
62906-1627
US

IV. Provider business mailing address

792 N MAIN ST BLDG M
ANNA IL
62906-1627
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-6302
  • Fax: 618-833-3603
Mailing address:
  • Phone: 217-222-9487
  • Fax: 217-222-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0046599
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number0046599
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT S EMLING
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 618-833-3602