Healthcare Provider Details

I. General information

NPI: 1487664025
Provider Name (Legal Business Name): GRAHAM HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W WALNUT ST
CANTON IL
61520-2443
US

IV. Provider business mailing address

210 W WALNUT ST
CANTON IL
61520-2444
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-4088
  • Fax: 309-649-5198
Mailing address:
  • Phone: 309-647-5240
  • Fax: 309-649-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001445
License Number StateIL

VIII. Authorized Official

Name: JULIE REEDER
Title or Position: VP OF FINANCE/CFO
Credential:
Phone: 309-647-5240