Healthcare Provider Details

I. General information

NPI: 1629582044
Provider Name (Legal Business Name): GOLDEN CIRCLE SENIOR CITIZENS COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 IL RT 146E
ELIZABETHTOWN IL
62931-9764
US

IV. Provider business mailing address

RR 1 BOX 191A
ELIZABETHTOWN IL
62931-9724
US

V. Phone/Fax

Practice location:
  • Phone: 618-287-5590
  • Fax: 618-287-5593
Mailing address:
  • Phone: 618-287-5590
  • Fax: 618-287-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOYCE MUGGE
Title or Position: CCP DIRECTOR
Credential:
Phone: 618-287-5590