Provider Demographics
NPI:1437367166
Name:JAVON BEA HOSPITAL
Entity Type:Organization
Organization Name:JAVON BEA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-756-6000
Mailing Address - Street 1:2400 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3655
Mailing Address - Country:US
Mailing Address - Phone:815-971-5000
Mailing Address - Fax:815-968-0170
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103
Practice Address - Country:US
Practice Address - Phone:815-971-5000
Practice Address - Fax:815-968-0170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002048273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN720850200Medicaid
CAXHSP30083Medicaid
WI11002400Medicaid
IA0927533Medicaid
IL14S239OtherIL MEDICARE
MO011307204Medicaid
NC1400239Medicaid
FL090109100Medicaid
IN100034510AMedicaid
PA1121340Medicaid
AR108771105Medicaid
372OtherBLUE CROSS BLUE SHEILD
=========OtherTRICARE CHAMPUS
NC1400239Medicaid
MN720850200Medicaid