Healthcare Provider Details

I. General information

NPI: 1780609925
Provider Name (Legal Business Name): JERSEY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2028
US

IV. Provider business mailing address

400 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2028
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-6402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number0001156
License Number StateIL

VIII. Authorized Official

Name: MICHELLE HOPPER
Title or Position: CFO
Credential:
Phone: 618-498-8349