Healthcare Provider Details

I. General information

NPI: 1669083655
Provider Name (Legal Business Name): ACCOLADE HEALTHCARE OF DANVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N LOGAN AVE
DANVILLE IL
61832-3715
US

IV. Provider business mailing address

9433 OLIVE BLVD # 100
SAINT LOUIS MO
63132-3132
US

V. Phone/Fax

Practice location:
  • Phone: 217-448-3106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MOSHE FREEDMAN
Title or Position: MANAGER
Credential:
Phone: 217-443-3106