Healthcare Provider Details

I. General information

NPI: 1336394865
Provider Name (Legal Business Name): DANVILLE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N BOWMAN AVENUE RD
DANVILLE IL
61832-2200
US

IV. Provider business mailing address

1701 N BOWMAN AVENUE RD
DANVILLE IL
61832-2200
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-2955
  • Fax:
Mailing address:
  • Phone: 217-443-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number0032862
License Number StateIL

VIII. Authorized Official

Name: MRS. KATHERINE J MURPHY
Title or Position: ASST. CONTROLLER
Credential: MHA
Phone: 217-637-2794