Provider Demographics
NPI:1861499659
Name:ASTA CARE CENTER OF FORD COUNTY
Entity Type:Organization
Organization Name:ASTA CARE CENTER OF FORD COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-379-4896
Mailing Address - Street 1:1240 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-4158
Mailing Address - Country:US
Mailing Address - Phone:217-379-4896
Mailing Address - Fax:217-379-2147
Practice Address - Street 1:1240 N MARKET ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4158
Practice Address - Country:US
Practice Address - Phone:217-379-4896
Practice Address - Fax:217-379-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045823314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL146005Medicare ID - Type Unspecified