Healthcare Provider Details

I. General information

NPI: 1790189462
Provider Name (Legal Business Name): CENTER FOR SIGHT & HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 MACINTOSH LN
ROCKFORD IL
61107-5300
US

IV. Provider business mailing address

8038 MACINTOSH LN
ROCKFORD IL
61107-5300
US

V. Phone/Fax

Practice location:
  • Phone: 815-332-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number1053487942
License Number StateIL

VIII. Authorized Official

Name: DIANE JONES
Title or Position: PRESIDENT
Credential:
Phone: 815-332-6801