Provider Demographics
NPI:1598768608
Name:DELNOR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:DELNOR COMMUNITY HOSPITAL
Other - Org Name:DELNOR COMMUNITY HOSPITAL HOME HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-208-4172
Mailing Address - Street 1:964 N 5TH AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1204
Mailing Address - Country:US
Mailing Address - Phone:630-513-0370
Mailing Address - Fax:630-513-8462
Practice Address - Street 1:964 N 5TH AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1204
Practice Address - Country:US
Practice Address - Phone:630-513-0370
Practice Address - Fax:630-513-8462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELNOR COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001627251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid
IL147093Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER