Provider Demographics
NPI:1336394865
Name:DANVILLE CARE CENTER
Entity Type:Organization
Organization Name:DANVILLE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:217-637-2794
Mailing Address - Street 1:1701 N BOWMAN AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-2200
Mailing Address - Country:US
Mailing Address - Phone:217-443-2955
Mailing Address - Fax:
Practice Address - Street 1:1701 N BOWMAN AVENUE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2200
Practice Address - Country:US
Practice Address - Phone:217-443-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0032862343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid