Healthcare Provider Details

I. General information

NPI: 1740534163
Provider Name (Legal Business Name): HOOPESTON RETIREMENT VILLAGE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N DIXIE HWY
HOOPESTON IL
60942-1033
US

IV. Provider business mailing address

115 W JEFFERSON ST SUITE 401
BLOOMINGTON IL
61701-3946
US

V. Phone/Fax

Practice location:
  • Phone: 217-283-8247
  • Fax: 217-283-6406
Mailing address:
  • Phone: 309-828-4361
  • Fax: 309-829-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CRAIG L ATER
Title or Position: EXEC VP, CFO
Credential:
Phone: 309-823-7135