Provider Demographics
NPI:1871566869
Name:HOSPICE CARE OF TAYLORVILLE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HOSPICE CARE OF TAYLORVILLE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:217-287-1402
Mailing Address - Street 1:100 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2216
Mailing Address - Country:US
Mailing Address - Phone:217-287-1402
Mailing Address - Fax:217-287-1457
Practice Address - Street 1:100 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2216
Practice Address - Country:US
Practice Address - Phone:217-287-1402
Practice Address - Fax:217-287-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL2001154251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
IL=========006Medicaid