=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124195557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY HARVARD HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 GRANT ST
-----------------------------------------------------
City | HARVARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60033-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-943-2967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 GRANT ST P O BOX 850
-----------------------------------------------------
City | HARVARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60033-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-943-2967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | SHANNON DUNPHY-ALEXANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-757-3126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0004911
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------