ILLINOIS VETERANS HOME AT QUINCY


Address: 1707 N 12th St, Quincy, IL 62301-1355
Phone: 2172228641

ILLINOIS VETERANS HOME AT QUINCY (NPI# 1386708568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1386708568
Entity Type Organization
Organization Name ILLINOIS VETERANS HOME AT QUINCY
Practice Address 1707 N 12th St
Quincy
IL 62301-1355
Mailing Address 1707 N 12th St
Bldg 29m
Quincy
IL 62301-1355
Practice Telephone 2172228641
Practice Fax Number 2172228578
Mailing Telephone 2172229487
Mailing Fax Number 2172228578
Enumeration Date 2006-12-21
Last Update Date 2010-07-15
Authorized Official Name BRUCE L VACA (ADMINISTRATOR)
Authorized Official Telephone 2172228641
Authorized Official Credential LNHA
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 332B00000X Durable Medical Equipment & Medical Supplies Suppliers
N 311ZA0620X Custodial Care Facility
Specialization: Adult Care Home
0044107 IL Nursing & Custodial Care Facilities
Y 320700000X Residential Treatment Facility, Physical Disabilities 44107 IL Residential Treatment Facilities

Other Provider Identifier

State Issuer Identifier Type Code
BCBS 00122001 01

Office Location

Street Address 1707 N 12TH ST
City QUINCY
State IL
Zip Code 62301-1355

Providers in the same location

NPI Name Taxonomy Address Enumeration
1508805086 Kathleen Ann Carter Social Worker 1707 N 12th St, Quincy, IL 62301-1355 2006-06-06
1447738034 Erin M Baker Social Worker 1707 N 12th St, Quincy, IL 62301-1355 2018-08-06
1902357395 Jessica Lynn Hamilton Social Worker 1707 N 12th St, Quincy, IL 62301-1355 2016-10-20
1639594666 Cynthia M Root Social Worker 1707 N 12th St, Quincy, IL 62301-1355 2014-02-27
1700199262 Linda L. Laws Registered Nurse 1707 N 12th St, Quincy, IL 62301-1355 2010-07-26
1992989214 Teresa A Allensworth Nurse Practitioner 1707 N 12th St, Quincy, IL 62301-1355 2007-12-21
1407045776 Kelvin R Roberts Social Worker 1707 N 12th St, Quincy, IL 62301-1355 2007-10-23
1447316450 Robert J Haas Social Worker 1707 N 12th St, Bldg 29m, Quincy, IL 62301-1397 2006-12-28
1154487163 Cynthia J Fritts Social Worker 1707 N 12th St, Quincy, IL 62301 2006-12-28
1962568972 Diane I Schultz Social Worker 1707 N 12th St, Quincy, IL 62301 2006-12-28
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1356969471 Lutheran Child and Family Service of Illinois Foster Care Agency 1400 N. 30th St, Quincy, IL 62301 2020-07-07
1134749716 Bethany Nicole Jumps Pharmacist Broadway St & N 11th St, Quincy, IL 62301 2020-04-23
1043844293 S.crider Construction An Supply Corp. Contractor 529 Woodbridge Dr., Quincy, IL 62301 2020-02-26
1245862002 Quincy Physicians & Surgeons Clinic, Sc Clinic/Center 3301 Broadway St., Quincy, IL 62301 2020-02-10
1043851488 West Central Illinois Nutrition In Home Supportive Care 639 York St. Room 333, Quincy, IL 62301 2019-10-07
1861986549 Quincy Physicians & Surgeons Clinic, Sc Internal Medicine 3347 Broadway St, Quincy, IL 62301 2018-06-18
1194255083 Michael Andrew Behrens Nurse Practitioner Broadway and 11th Street, Quincy, IL 62301 2017-06-14
1770987323 Kirsty Yvonne Reed Counselor 205 S. 24th Street, Chaddock, Quincy, IL 62301 2014-10-10
1114234499 Dale D. Shahan Dds Ltd Dentist 636 Hampshire Suite 102, Quincy, IL 62301 2010-09-08
1730314071 James D Kaufmann Pharmacist 14th & Broadway, Quincy, IL 62301 2009-05-15
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Taxonomy Information

Taxonomy Code 320700000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Physical Disabilities

Taxonomy Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently.
Notes: [7/1/2003: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1356890453 Dhs Residential Treatment Facility, Physical Disabilities 109 W Wilson St, Fairfield, IL 62837-1816 2016-09-30
1790150340 Mary Kay Yarak Residential Treatment Facility, Physical Disabilities 1537 N Washtenaw Ave, Chicago, IL 60622-1636 2015-12-08
1629448592 Lilia Perez Residential Treatment Facility, Physical Disabilities 225 Westview St, Hoffman Estates, IL 60169-3055 2015-10-04
1912394354 Rehab Care Residential Treatment Facility, Physical Disabilities 5112 Johnson Ave, Western Springs, IL 60558-1913 2015-04-23
1871897694 Unicare Home Health Inc. Residential Treatment Facility, Physical Disabilities 3862 Rita Dr, Richton Park, IL 60471-1283 2011-01-09
1598942252 Home Bound Eye Care Services Ltd Residential Treatment Facility, Physical Disabilities 5301 Touhy Ave, Suite 100, Skokie, IL 60077-3247 2008-01-24
1922185958 Dav-kim Portable X Ray Service Co Residential Treatment Facility, Physical Disabilities 8235 Christiana Ave, Skokie, IL 60076-2910 2006-11-01
1609890235 State of Illinois Residential Treatment Facility, Physical Disabilities 2424w.charleston, Chicago, IL 60647 2006-07-27
1619359866 Ton Shen Health, Inc. Residential Treatment Facility, Physical Disabilities 665 Pasquinelli Dr, Suite 203, Westmont, IL 60559-1279 2015-06-24
1285013235 Quality Therapy and Consultation Residential Treatment Facility, Physical Disabilities 28w141 Liberty St, Winfield, IL 60190-1955 2015-05-22
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Competitor

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City QUINCY
Zip Code 62301

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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