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NPI Code Detail

MEDICARE: EGYPTIAN PUBLIC AND MENTAL HEALTH DEPARTMENT

MEDICARE: EGYPTIAN PUBLIC AND MENTAL HEALTH DEPARTMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency0027100002IL
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center0027100002IL

General Provider Information

NPI Number : 1134396195
Entity Type Code : Organization
Provider Name (Legal Business Name) : EGYPTIAN PUBLIC AND MENTAL HEALTH DEPARTMENT
Provider Business Mailing Address
First Line : 1412 US HIGHWAY 45 N
Second Line :
City : ELDORADO
State : IL
Zip : 62930-3766
Country : US
Telephone Number : 618-273-3326
Fax Number : 618-273-2808
Provider Business Practice Location Address
First Line : 1412 US HIGHWAY 45 N
Second Line :
City : ELDORADO
State : IL
Zip : 62930-3766
Country : US
Telephone Number : 618-273-3326
Fax Number : 618-273-2808
Authorized Official
Title or Position : CEO
Name : ANGIE HAMPTON
Credential :
Telephone Number : 618-273-3326
Provider Enumeration Date : 05/09/2008
Last Update Date : 05/28/2020

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1013287275 — DONNA K WHITE-LAND MSW, LCSW, QMHP
Practice Location Address:
1412 US HIGHWAY 45 N
ELDORADO, IL
62930-3766
Practice Phone: 618-273-3326
Practice Fax: 618-273-2808

Directions to “EGYPTIAN PUBLIC AND MENTAL HEALTH DEPARTMENT ” Practice Location

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