Healthcare Provider Details

I. General information

NPI: 1528068087
Provider Name (Legal Business Name): COUNTY OF MERCER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 NW 9TH AVE
ALEDO IL
61231-1258
US

IV. Provider business mailing address

409 NW 9TH AVE
ALEDO IL
61231-1258
US

V. Phone/Fax

Practice location:
  • Phone: 309-582-5301
  • Fax:
Mailing address:
  • Phone: 309-582-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1003482
License Number StateIL

VIII. Authorized Official

Name: MARJIE EARL
Title or Position: DIRECTOR
Credential: RN
Phone: 309-582-5301