Provider Demographics
NPI:1760427827
Name:HALLMARK HOUSE CORPORATION
Entity Type:Organization
Organization Name:HALLMARK HOUSE CORPORATION
Other - Org Name:HALLMARK HOUSE NURSING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-815-9041
Mailing Address - Street 1:2501 ALLENTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554
Mailing Address - Country:US
Mailing Address - Phone:309-347-3121
Mailing Address - Fax:309-347-3607
Practice Address - Street 1:2501 ALLENTOWN ROAD
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554
Practice Address - Country:US
Practice Address - Phone:309-347-3121
Practice Address - Fax:309-347-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036343314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145691Medicare ID - Type Unspecified
IL=========001Medicaid
ILT=========OtherBLUE CROSS BLUE SHIELD