Healthcare Provider Details

I. General information

NPI: 1063505006
Provider Name (Legal Business Name): COUNTY OF WILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 DORIS AVE
JOLIET IL
60433-2569
US

IV. Provider business mailing address

421 DORIS AVE
JOLIET IL
60433-2569
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-8710
  • Fax: 815-727-8637
Mailing address:
  • Phone: 815-727-8710
  • Fax: 815-727-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0014076
License Number StateIL

VIII. Authorized Official

Name: MRS. KAREN SORBERO
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 815-727-8650