Provider Demographics
NPI:1659382893
Name:SALEM TOWNSHIP HOSPITAL
Entity Type:Organization
Organization Name:SALEM TOWNSHIP HOSPITAL
Other - Org Name:SALEM TOWNSHIP HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUHRHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-3194
Mailing Address - Street 1:1201 RICKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-548-3194
Mailing Address - Fax:618-548-6831
Practice Address - Street 1:1201 RICKER DRIVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-3194
Practice Address - Fax:618-548-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002880251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9936OtherBLUE CROSS HOME HEALTH
IL102929OtherHEALTHLINK
IL5286399OtherUNITED HEALTHCARE
IL9936OtherBLUE CROSS HOME HEALTH
IL=========003Medicaid