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General NPI Number Information
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NPI Number | 1699973891
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Entity Type | Organization
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Legal Business Name | VA ILLIANA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 E MAIN ST
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City | DANVILLE
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State | IL
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Zip | 61832-5100
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Country | US
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Telephone | 217-554-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-1615
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Country | US
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Telephone | 217-766-6901
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Fax |
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MORI A WILLIAMS
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Credential | RN
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Telephone | 217-554-5518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State | IL
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