Healthcare Provider Details

I. General information

NPI: 1427352756
Provider Name (Legal Business Name): ASTA CARE CENTER OF COLFAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S HARRISON ST
COLFAX IL
61728-7536
US

IV. Provider business mailing address

402 S HARRISON ST
COLFAX IL
61728-7536
US

V. Phone/Fax

Practice location:
  • Phone: 309-723-2591
  • Fax:
Mailing address:
  • Phone: 309-723-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0051227
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier145992
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE NUMBER

VIII. Authorized Official

Name: MR. CRAIG FRANK
Title or Position: VP OF FINANCE
Credential:
Phone: 847-742-8822