Healthcare Provider Details

I. General information

NPI: 1871566869
Provider Name (Legal Business Name): HOSPICE CARE OF TAYLORVILLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W FRANKLIN ST
TAYLORVILLE IL
62568-2216
US

IV. Provider business mailing address

100 W FRANKLIN ST
TAYLORVILLE IL
62568-2216
US

V. Phone/Fax

Practice location:
  • Phone: 217-287-1402
  • Fax: 217-287-1457
Mailing address:
  • Phone: 217-287-1402
  • Fax: 217-287-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberIL2001154
License Number StateIL

VIII. Authorized Official

Name: MRS. TRACY L SEATON
Title or Position: DIRECTOR
Credential: RN, BSN
Phone: 217-287-1402