Provider Demographics
NPI:1114096260
Name:COLONIAL ACRES HEALTH CARE CENTRE INC
Entity Type:Organization
Organization Name:COLONIAL ACRES HEALTH CARE CENTRE INC
Other - Org Name:NEW BEGINNINGS CARE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-0044
Mailing Address - Street 1:1625 S 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2828
Mailing Address - Country:US
Mailing Address - Phone:217-528-0044
Mailing Address - Fax:217-528-3412
Practice Address - Street 1:1000 DIXON AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071
Practice Address - Country:US
Practice Address - Phone:815-625-8510
Practice Address - Fax:815-625-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL145988Medicare ID - Type Unspecified