Healthcare Provider Details

I. General information

NPI: 1841295763
Provider Name (Legal Business Name): IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FAIRMAN AVE
WATSEKA IL
60970-1644
US

IV. Provider business mailing address

200 E FAIRMAN AVE
WATSEKA IL
60970-1644
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-0185
  • Fax: 815-432-6199
Mailing address:
  • Phone: 815-432-0185
  • Fax: 815-432-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2002400
License Number StateIL

VIII. Authorized Official

Name: MICHAEL TILSTRA
Title or Position: CEO
Credential:
Phone: 815-432-7777