Provider Demographics
NPI:1447242169
Name:COUNTY OF ROCK ISLAND
Entity Type:Organization
Organization Name:COUNTY OF ROCK ISLAND
Other - Org Name:HOPE CREEK CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:309-796-6600
Mailing Address - Street 1:4343 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4203
Mailing Address - Country:US
Mailing Address - Phone:309-796-6600
Mailing Address - Fax:309-796-6601
Practice Address - Street 1:4343 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4203
Practice Address - Country:US
Practice Address - Phone:309-796-6600
Practice Address - Fax:309-796-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0048694314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0048694OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH
IL0048694OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH
IL0698550001Medicare NSC
IL0048694OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH