Provider Demographics
NPI:1154143642
Name:JAVON BEA HOSPITAL
Entity type:Organization
Organization Name:JAVON BEA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-971-6752
Mailing Address - Street 1:3401 N PERRYVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8011
Mailing Address - Country:US
Mailing Address - Phone:815-971-1025
Mailing Address - Fax:815-971-9412
Practice Address - Street 1:3401 N PERRYVILLE ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8011
Practice Address - Country:US
Practice Address - Phone:815-971-1025
Practice Address - Fax:815-971-9412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-28
Last Update Date:2025-01-08
Deactivation Date:2024-12-27
Deactivation Code:
Reactivation Date:2025-01-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy