Healthcare Provider Details

I. General information

NPI: 1235340951
Provider Name (Legal Business Name): MASON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E LAUREL AVE
HAVANA IL
62644-6973
US

IV. Provider business mailing address

1002 E LAUREL AVE
HAVANA IL
62644-6973
US

V. Phone/Fax

Practice location:
  • Phone: 309-210-0110
  • Fax: 309-543-2063
Mailing address:
  • Phone: 309-210-0110
  • Fax: 309-543-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA TOWERY
Title or Position: ADMINISTRATOR
Credential:
Phone: 309-210-0110