Healthcare Provider Details

I. General information

NPI: 1699882191
Provider Name (Legal Business Name): HAMMOND HENRY DIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

IV. Provider business mailing address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

V. Phone/Fax

Practice location:
  • Phone: 309-944-6431
  • Fax:
Mailing address:
  • Phone: 309-944-6431
  • Fax: 309-944-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JODIE CRISWELL
Title or Position: CFO
Credential:
Phone: 309-944-6431