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General NPI Number Information
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NPI Number | 1144790791
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Entity Type | Organization
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Legal Business Name | JAVON BEA HOSPITAL
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 8201 E RIVERSIDE BLVD STE 1022
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-1100
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Fax | 815-971-9084
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Provider Business Mailing Address
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Address Line | 8201 E RIVERSIDE BLVD STE 1022
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-1100
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Fax | 815-971-9084
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Authorized Official
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Title or Position | CFO
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Name | JOSEPH D MALAS
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Credential |
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Telephone | 815-971-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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