Provider Demographics
NPI:1558467936
Name:DANVILLE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:DANVILLE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/COLLECTIONS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-424-1021
Mailing Address - Street 1:26 W WEST NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-7488
Mailing Address - Country:US
Mailing Address - Phone:217-446-1400
Mailing Address - Fax:217-446-5907
Practice Address - Street 1:26 W WEST NEWELL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-7488
Practice Address - Country:US
Practice Address - Phone:217-446-1400
Practice Address - Fax:217-446-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002363261QA1903X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
141084Medicare ID - Type Unspecified
IL=========001Medicaid