Healthcare Provider Details

I. General information

NPI: 1922541572
Provider Name (Legal Business Name): MOLINE NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 34TH AVE
MOLINE IL
61265-5842
US

IV. Provider business mailing address

7300 34TH AVE
MOLINE IL
61265-5842
US

V. Phone/Fax

Practice location:
  • Phone: 309-792-5940
  • Fax: 309-792-5975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMES MASON
Title or Position: PRESIDENT
Credential:
Phone: 813-347-7425