Basic Information
| Provider Information | |||||||||
| NPI: | 1659382893 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SALEM TOWNSHIP HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SALEM TOWNSHIP HOSPITAL HOME HEALTH AGENCY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 RICKER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
| FaxNumber: | 6185486831 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 RICKER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
| FaxNumber: | 6185486831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FUHRHOP | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6185483194 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1002880 | IL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 9936 | 01 | IL | BLUE CROSS HOME HEALTH | OTHER | 102929 | 01 | IL | HEALTHLINK | OTHER | 5286399 | 01 | IL | UNITED HEALTHCARE | OTHER |