Healthcare Provider Details

I. General information

NPI: 1629118609
Provider Name (Legal Business Name): JAVON BEA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

IV. Provider business mailing address

8201 E RIVERSIDE BLVD
ROCKFORD IL
61114-2300
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-7000
  • Fax: 815-968-4795
Mailing address:
  • Phone: 815-971-7000
  • Fax: 815-968-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0002048
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICIA LYNNE ALLEN
Title or Position: CFO
Credential:
Phone: 608-756-6080