1427165752 NPI number — MERCYHEALTH VISITING NURSES ASSOCIATION, INC.

Table of content: (NPI 1427165752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427165752 NPI number — MERCYHEALTH VISITING NURSES ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCYHEALTH VISITING NURSES ASSOCIATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427165752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4223 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-971-3550
Provider Business Mailing Address Fax Number:
815-971-3500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9934 N ALPINE RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACHESNEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61115-8240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-971-3330
Provider Business Practice Location Address Fax Number:
815-282-2210
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EIBL
Authorized Official First Name:
DANETTE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
815-971-5944

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  203.000267 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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