Covenant Care Of Jacksonville Llc, NPI 1396811550
Nursing Facility/Intermediate Care Facility in Jacksonville, IL, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1396811550
NPI Entity Type Organization
Provider Name Covenant Care Of Jacksonville Llc
Doing Business As
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 1500 West Walnut Street, Jacksonville, IL, US
Provider Mailing Address 1200 Mountain Creek Road, Suite 350, Chattanooga, TN, US, 374056103
Is Sole Proprietor? No
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Organization Official

Official Name Gary L Potts
Official Position MANAGER
Phone 423-870-3153

Primary Taxonomy

Taxonomy Code

313M00000X

Taxonomy Name Nursing Facility/Intermediate Care Facility
Classification

Nursing Facility/Intermediate Care Facility

Group

Nursing & Custodial Care Facilities

License No. 1764855
License State IL
Description An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

Other Organization Name

Modern Care Convalescent and Nursing Home
Doing Business As

Business Address

Covenant Care Of Jacksonville Llc
1500 West Walnut Street

Jacksonville, IL, US

Phone: 217-245-4183
Fax: 217-243-2915

Mailing Address

Covenant Care Of Jacksonville Llc
1200 Mountain Creek Road
Suite 350
Chattanooga, TN, US
ZIP 374056103
Phone: 423-870-3153
Fax: 423-870-3196

Secondary Taxonomies

Taxonomy Code Group Classification License No. State Primary?

314000000X

Nursing & Custodial Care Facilities

Skilled Nursing Facility

0047852 IL No

Other Providers in IL, US

NPI Name Taxonomy Address

1194448480

Dr. Lucas Tanner, Llc

Organization

Clinic/Center

132 Depot St

Gardner, IL

1467077537

NP Rebbecca Camerer

Individual

Family Nurse Practitioner

20733 N Broad St

Carlinville, IL

1306564521

DNP Lindsay Renee Wayne

Individual

Certified Registered Nurse Anesthetist

1740 W Taylor St # 3200w

Chicago, IL

1609378074

LMFT Sara R Gallant

Individual

Marriage & Family Therapist

4709 Golf Rd Ste 1150

Skokie, IL

1790337483

MD Mandeep Kaur Sidhu

Individual

Geriatric Medicine (Internal Medicine) Physician

Ui Health, Graduate Medical Education Office

820 South Wood Street, Suite 100, Mc 675

Chicago, IL

1295259042

FNP Melissa Verdecchia

Individual

Family Nurse Practitioner

400 N Highland Ave

Aurora, IL

1477949014

LCSW Jennifer Anne Murphy

Individual

Clinical Social Worker

527 Illinois Ave

St Charles, IL

1669147302

DR. DMD Kelly Walker

Individual

General Practice Dentistry

101 Fulton St

Wilmington, IL

1609515832

DR. Christopher Alexander Delgado

Individual

Certified Registered Nurse Anesthetist

2233 W Division St

Chicago, IL

1578215752

APRN, FNP-C Amanda Rose Malone

Individual

Nurse Practitioner

251 E Huron St

Chicago, IL

1568007433

LCOC Christina Joly

Individual

Professional Counselor

5537 N Broadway St

Chicago, IL

1124749700

Jonathan Patrick Ruiz

Organization

Surgical Physician Assistant

1900 Light Rd Apt 103

Oswego, IL

1871244426

CSFA Jonathan P Ruiz

Individual

Surgical Physician Assistant

1900 Light Rd Apt 103

Oswego, IL

1679916704

DR. MD Arielle Cimeno

Individual

Transplant Surgery Physician

5841 S Maryland Ave # Mc5206

Chicago, IL

1225789209

Aaa Medical Inc

Organization

Clinical Medical Laboratory

103 W Townline Rd

Vernon Hills, IL

1568642015

DR. PSY.D Iwona Konczak

Individual

Clinical Psychologist

415 W Golf Rd

Suite 4

Arlington Heights, IL

1780257329

Alexi Feiner Child

Individual

Medical Physician Assistant

2403 N Clybourn Ave Apt 3

Chicago, IL

1750006128

Kristine Joy Mique

Individual

Pharmacist

3325 N Main St

Rockford, IL

1568990364

MR. LCSW Christopher Digiovanni

Individual

Clinical Social Worker

201 Park Pl Ste 2

Bourbonnais, IL

1356075873

Julieanne Pojas, Psy.d. & Associates Pllc

Organization

Clinical Psychologist

153 Pointe Dr Unit 106

Northbrook, IL

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