Healthcare Provider Details

I. General information

NPI: 1750429742
Provider Name (Legal Business Name): SALEM TOWNSHIP HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER RD
SALEM IL
62881-4263
US

IV. Provider business mailing address

412 BRIARWOOD DR
SALEM IL
62881-2549
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax: 618-548-4902
Mailing address:
  • Phone: 618-548-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. CHRISTINE GRACE LOUISE ZINZILIETA
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 618-548-3194