Provider Demographics
NPI:1326105636
Name:ILLINOIS VETERANS HOME AT ANNA
Entity Type:Organization
Organization Name:ILLINOIS VETERANS HOME AT ANNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:EMLING
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:618-833-3602
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:BLDG M
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1627
Mailing Address - Country:US
Mailing Address - Phone:217-222-9487
Mailing Address - Fax:217-222-8578
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1627
Practice Address - Country:US
Practice Address - Phone:618-833-6302
Practice Address - Fax:618-833-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046599311ZA0620X, 320700000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
09132008OtherBCBS
208774Medicare PIN
DC1501Medicare PIN
09132008OtherBCBS