Provider Demographics
NPI:1194857490
Name:HOPEDALE MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:HOPEDALE MEDICAL FOUNDATION
Other - Org Name:HOPEDALE MEDICAL COMPLEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:NELLO
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-449-4338
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-0267
Mailing Address - Country:US
Mailing Address - Phone:309-449-3321
Mailing Address - Fax:309-449-5441
Practice Address - Street 1:107 TREMONT
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-0267
Practice Address - Country:US
Practice Address - Phone:309-449-3321
Practice Address - Fax:309-449-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1706400275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-Z330Medicare ID - Type UnspecifiedPROVIDER NUMBER