Healthcare Provider Details

I. General information

NPI: 1699973685
Provider Name (Legal Business Name): THOMAS H. BOYD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCHOOL ST
CARROLLTON IL
62016-1436
US

IV. Provider business mailing address

800 SCHOOL ST
CARROLLTON IL
62016-1436
US

V. Phone/Fax

Practice location:
  • Phone: 217-942-9410
  • Fax: 217-942-6091
Mailing address:
  • Phone: 217-942-9410
  • Fax: 217-942-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0002782
License Number StateIL

VIII. Authorized Official

Name: STACE HOLLAND
Title or Position: CEO
Credential:
Phone: 217-942-6946