Provider Demographics
NPI:1639187149
Name:SPARTA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SPARTA COMMUNITY HOSPITAL
Other - Org Name:AT-HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNSTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-443-2177
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-0297
Mailing Address - Country:US
Mailing Address - Phone:618-443-1337
Mailing Address - Fax:618-443-1383
Practice Address - Street 1:203 S. VINE STREET
Practice Address - Street 2:BROADWAY PLAZA SUITE 5
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286
Practice Address - Country:US
Practice Address - Phone:618-443-2177
Practice Address - Fax:618-443-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1009653251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5080OtherBCBS PROVIDER NUMBER
IL=========Medicaid
IL1009653OtherIDPH ID NUMBER
IL=========003Medicaid