Modern Care Convalescent And Nursing Home
LBN: Covenant Care Of Jacksonville Llc
Modern Care Convalescent And Nursing Home is an health care organization with primary practice located at 1500 West Walnut Street , Jacksonville IL 62650-1134. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, Nursing & Custodial Care Facilities / Skilled Nursing Facility. Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility is the primary health care specialty.
Covenant Care Of Jacksonville Llc can be contacted via phone (217) 245-4183, or through Potts, Gary L via phone (423) 870-3153.
Contact Information
Primary practice address
1500 West Walnut Street
Jacksonville IL 62650-1134
Phone: (217) 245-4183
Fax: (217) 243-2915
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility | 313M00000X | 1764855 | Illinois |
| Nursing & Custodial Care Facilities / Skilled Nursing Facility | 314000000X | 0047852 | Illinois |
Profile Details
| NPI number | 1396811550 |
|---|---|
| LBN Legal business name | Covenant Care Of Jacksonville Llc |
| DBA Doing business as | Modern Care Convalescent And Nursing Home |
| Authorized official | Potts, Gary L |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Jul 19th, 2007 - about 17 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396811550 | NPPES |
| Illinois | MEDICAID | 0036301 |
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