Healthcare Provider Details

I. General information

NPI: 1154143642
Provider Name (Legal Business Name): JAVON BEA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date: 12/27/2024
Reactivation Date: 01/08/2025

III. Provider practice location address

3401 N PERRYVILLE ROAD
ROCKFORD IL
61114-8011
US

IV. Provider business mailing address

3401 N PERRYVILLE RD
ROCKFORD IL
61114-8011
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-1025
  • Fax: 815-971-9412
Mailing address:
  • Phone: 815-971-1025
  • Fax: 815-971-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHANNON DUNPHY-ALEXANDER
Title or Position: CFO
Credential:
Phone: 608-757-3126