Healthcare Provider Details

I. General information

NPI: 1194857490
Provider Name (Legal Business Name): HOPEDALE MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TREMONT
HOPEDALE IL
61747-0267
US

IV. Provider business mailing address

PO BOX 267
HOPEDALE IL
61747-0267
US

V. Phone/Fax

Practice location:
  • Phone: 309-449-3321
  • Fax: 309-449-5441
Mailing address:
  • Phone: 309-449-3321
  • Fax: 309-449-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number1706400
License Number StateIL

VIII. Authorized Official

Name: DR. ALFRED NELLO ROSSI
Title or Position: CEO
Credential: M.D.
Phone: 309-449-4338