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:
Map and Directions
Authorized official contact:
Name: Potts, Gary L
Phone: (423) 870-3153

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396811550 NPPES
Illinois MEDICAID 0036301

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