Organization
ILLINOIS VETERANS HOME AT QUINCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE L VACA LNHA (ADMINISTRATOR)
(217) 222-8641
Entity
Organization
Contact information
Practice address
1707 N 12TH ST, QUINCY, IL 62301-1355
(217) 222-8641
(217) 222-8578
Mailing address
1707 N 12TH ST, BLDG 29M, QUINCY, IL 62301-1355
(217) 222-9487
(217) 222-8578
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
0044107
IL
320700000X
Physical Disabilities Residential Treatment Facility
Primary
44107
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00122001
BCBS
—
Enumeration date
12/21/2006
Last updated
07/15/2010
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