=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639187149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARTA COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 BROADWAY PLZ
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62286-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-443-2177
-----------------------------------------------------
Fax | 618-443-1354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 297
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62286-0297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-443-1337
-----------------------------------------------------
Fax | 618-443-1383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. LISA ERNSTING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-443-2177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1009653
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------