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General NPI Number Information
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NPI Number | 1295732360
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Entity Type | Organization
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Legal Business Name | MID AMERICACARE FOUNDATION
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 703 E BUFFALO ST
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City | POLO
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State | IL
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Zip | 61064-1701
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Country | US
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Telephone | 815-946-2203
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Fax | 815-946-2859
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Provider Business Mailing Address
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Address Line | 703 E BUFFALO ST
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City | POLO
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State | IL
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Zip | 61064-1701
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Country | US
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Telephone | 815-946-2203
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Fax | 815-946-2859
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | JOSEPH C TUTERA
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Credential |
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Telephone | 816-444-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0028852
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License Number State | IL
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