Healthcare Provider Details

I. General information

NPI: 1861465213
Provider Name (Legal Business Name): TAYLORVILLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E PLEASANT ST
TAYLORVILLE IL
62568-1562
US

IV. Provider business mailing address

201 E PLEASANT ST
TAYLORVILLE IL
62568-1562
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-3331
  • Fax: 217-824-1624
Mailing address:
  • Phone: 217-824-3331
  • Fax: 217-824-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL J RAAB
Title or Position: CEO
Credential:
Phone: 217-824-3331