Healthcare Provider Details

I. General information

NPI: 1265548010
Provider Name (Legal Business Name): MASON HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 E LAUREL AVE
HAVANA IL
62644-1551
US

IV. Provider business mailing address

615 N. PROMENADE
HAVANA IL
62644-0530
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-6137
  • Fax: 309-543-4442
Mailing address:
  • Phone: 309-543-6137
  • Fax: 309-543-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number001002088
License Number StateIL

VIII. Authorized Official

Name: MR. HARRY WOLIN
Title or Position: CEO
Credential:
Phone: 309-543-4431