Healthcare Provider Details

I. General information

NPI: 1306846258
Provider Name (Legal Business Name): MIDAMERICA CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E CARL SANDBURG DR
GALESBURG IL
61401-1249
US

IV. Provider business mailing address

275 E CARL SANDBURG DR
GALESBURG IL
61401-1249
US

V. Phone/Fax

Practice location:
  • Phone: 309-344-1151
  • Fax: 309-344-2007
Mailing address:
  • Phone: 309-344-1151
  • Fax: 309-344-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0031245
License Number StateIL

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 816-444-0900