MEDICARE: JULIA RACKLEY PERRY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1000041	IL

General Provider Information

NPI Number	:	1932191806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIA RACKLEY PERRY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	530 PARK AVE E
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-3901
Country	:	US
Telephone Number	:	815-875-4114
Fax Number	:	815-875-4112

Provider Business Practice Location Address
First Line	:	530 PARK AVE E
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-3901
Country	:	US
Telephone Number	:	815-875-4114
Fax Number	:	815-875-4112

Authorized Official
Title or Position	:	DIRECTOR
Name	:	COLLEEN SAILER
Credential	:	BSN
Telephone Number	:	815-875-4114

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/06/2020

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