Provider Demographics
NPI:1114943008
Name:BEULAH LAND CHRISTIAN HOME
Entity Type:Organization
Organization Name:BEULAH LAND CHRISTIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-732-5128
Mailing Address - Street 1:201 E FALCON HWY
Mailing Address - Street 2:
Mailing Address - City:FLANAGAN
Mailing Address - State:IL
Mailing Address - Zip Code:61740-9108
Mailing Address - Country:US
Mailing Address - Phone:815-796-2267
Mailing Address - Fax:815-796-4434
Practice Address - Street 1:201 E FALCON HWY
Practice Address - Street 2:
Practice Address - City:FLANAGAN
Practice Address - State:IL
Practice Address - Zip Code:61740-9108
Practice Address - Country:US
Practice Address - Phone:815-796-2267
Practice Address - Fax:815-796-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0006767314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371080266001Medicaid
IL=========014Medicaid
IL=========014Medicaid