1467428466 NPI number — ST. MARGARET'S HEALTH-PERU

Table of content: (NPI 1467428466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467428466 NPI number — ST. MARGARET'S HEALTH-PERU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARGARET'S HEALTH-PERU
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:
ILLINOIS VALLEY HOSPICE
Provider Other Organization Name Type Code:
3
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:
1467428466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERU
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61354-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-224-1307
Provider Business Mailing Address Fax Number:
815-224-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61354-2759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-224-1307
Provider Business Practice Location Address Fax Number:
815-224-1665
Provider Enumeration Date:
02/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LYNCH
Authorized Official First Name:
LISA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
AVP OF FINANCE
Authorized Official Telephone Number:
815-780-3574

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2000677 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9558 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".