Healthcare Provider Details

I. General information

NPI: 1518917756
Provider Name (Legal Business Name): HANCOCK COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S ADAMS ST
CARTHAGE IL
62321-1600
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-8566
  • Fax: 217-357-6564
Mailing address:
  • Phone: 217-357-8566
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000091
License Number StateIL

VIII. Authorized Official

Name: ADA M BAIR
Title or Position: CEO
Credential:
Phone: 217-357-8566