Provider Demographics
NPI:1821053216
Name:ROCHELLE COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:ROCHELLE COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PFS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-562-2181
Mailing Address - Street 1:900 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1764
Mailing Address - Country:US
Mailing Address - Phone:815-562-2181
Mailing Address - Fax:815-561-3121
Practice Address - Street 1:900 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1764
Practice Address - Country:US
Practice Address - Phone:815-562-2181
Practice Address - Fax:815-561-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL002022282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL007047OtherTRICARE
IL007115580OtherBLUE CROSS PROFESSIONAL BILLING
IL256OtherBLUE CROSS
IL007115580OtherBLUE CROSS PROFESSIONAL BILLING
ILL007047OtherTRICARE
822760Medicare PIN
IL007115580OtherBLUE CROSS PROFESSIONAL BILLING
IL=========001Medicaid
822700Medicare PIN