Healthcare Provider Details

I. General information

NPI: 1649270729
Provider Name (Legal Business Name): JERSEY COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 STATE HIGHWAY 109
JERSEYVILLE IL
62052
US

IV. Provider business mailing address

1307 STATE HIGHWAY 109
JERSEYVILLE IL
62052-2396
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-9565
  • Fax: 618-498-6291
Mailing address:
  • Phone: 618-498-9565
  • Fax: 618-498-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001577
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEIDI CARTER
Title or Position: PUBLIC HEALTH ADMINISTRATOR
Credential: RN
Phone: 618-498-9565