Provider Demographics
NPI:1689694986
Name:HEARTLAND CHRISTIAN VILLAGE, LLC
Entity Type:Organization
Organization Name:HEARTLAND CHRISTIAN VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
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:217-732-5175
Mailing Address - Street 1:101 TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEOGA
Mailing Address - State:IL
Mailing Address - Zip Code:62447-1121
Mailing Address - Country:US
Mailing Address - Phone:217-895-2665
Mailing Address - Fax:217-895-3399
Practice Address - Street 1:101 TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NEOGA
Practice Address - State:IL
Practice Address - Zip Code:62447-1121
Practice Address - Country:US
Practice Address - Phone:217-895-2665
Practice Address - Fax:217-895-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038372314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL146030Medicare Oscar/Certification