Healthcare Provider Details

I. General information

NPI: 1003038480
Provider Name (Legal Business Name): SNYDER'S VAUGHN-HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S MORGAN ST
RUSHVILLE IL
62681-1617
US

IV. Provider business mailing address

135 S MORGAN ST
RUSHVILLE IL
62681-1617
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-3420
  • Fax: 217-322-2828
Mailing address:
  • Phone: 217-322-3420
  • Fax: 217-322-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0005363
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN R SNYDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 217-322-3201