Healthcare Provider Details

I. General information

NPI: 1598761033
Provider Name (Legal Business Name): COUNTY OF MCDONOUGH MCDONOUGH COUNTY CLERK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 MADELYN AVENUE
MACOMB IL
61455
US

IV. Provider business mailing address

1212 MADELYN AVENUE
MACOMB IL
61455
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-5482
  • Fax: 309-833-1054
Mailing address:
  • Phone: 309-837-5482
  • Fax: 309-833-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0021568
License Number StateIL

VIII. Authorized Official

Name: MONICA WINDSOR
Title or Position: INTERIM ADMINISTRATOR
Credential: AUTHRORIZED OFFICIAL
Phone: 309-837-5482