Healthcare Provider Details

I. General information

NPI: 1336621572
Provider Name (Legal Business Name): ACCOLADE HEALTHCARE OF THE HEARTLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E PELLS ST
PAXTON IL
60957-1300
US

IV. Provider business mailing address

1001 E PELLS ST
PAXTON IL
60957-1300
US

V. Phone/Fax

Practice location:
  • Phone: 217-379-4361
  • Fax:
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: MOSHE FREEDMAN
Title or Position: MANAGER
Credential:
Phone: 217-379-4361