Provider Demographics
NPI:1619276524
Name:HICKORY POINT CHRISTIAN VILLAGE, INC.
Entity Type:Organization
Organization Name:HICKORY POINT CHRISTIAN VILLAGE, INC.
Other - Org Name:HICKORY POINT CHRISTIAN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FIANANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-587-7903
Mailing Address - Street 1:565 W MARION AVE
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-2099
Mailing Address - Country:US
Mailing Address - Phone:217-872-1122
Mailing Address - Fax:
Practice Address - Street 1:565 W MARION AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-2099
Practice Address - Country:US
Practice Address - Phone:217-872-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HICKORY POINT CHRISTIAN VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-17
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid