Provider Demographics
NPI:1003836560
Name:HOSPICE OF THE ROCK RIVER VALLEY
Entity Type:Organization
Organization Name:HOSPICE OF THE ROCK RIVER VALLEY
Other - Org Name:ROCK RIVER HOSPICE AND HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:815-625-3858
Mailing Address - Street 1:2706 AVE. E
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4602
Mailing Address - Country:US
Mailing Address - Phone:815-625-3858
Mailing Address - Fax:815-625-6152
Practice Address - Street 1:2706 AVE. E
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-4602
Practice Address - Country:US
Practice Address - Phone:815-625-3858
Practice Address - Fax:815-625-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000164251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
141552Medicare ID - Type Unspecified