Healthcare Provider Details

I. General information

NPI: 1063103190
Provider Name (Legal Business Name): CENTRAL ILLINOIS SNF CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W WALNUT ST
JACKSONVILLE IL
62650-1133
US

IV. Provider business mailing address

1517 W WALNUT ST
JACKSONVILLE IL
62650-1133
US

V. Phone/Fax

Practice location:
  • Phone: 630-336-5620
  • Fax:
Mailing address:
  • Phone: 630-336-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: BHAVIN VALLABHBHAI SONANI
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 630-336-5620