Healthcare Provider Details

I. General information

NPI: 1497471767
Provider Name (Legal Business Name): DEACONESS ILLINOIS RED BUD REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W SOUTH 1ST ST
RED BUD IL
62278-1116
US

IV. Provider business mailing address

PO BOX 631946
CINCINNATI OH
45263-1946
US

V. Phone/Fax

Practice location:
  • Phone: 618-282-3891
  • Fax: 618-282-4070
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: JARED STIMPSON
Title or Position: TREASURER
Credential:
Phone: 812-450-8287