Healthcare Provider Details

I. General information

NPI: 1477686780
Provider Name (Legal Business Name): GRUNDY COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 UNION ST
MORRIS IL
60450-2426
US

IV. Provider business mailing address

1320 UNION ST
MORRIS IL
60450-2426
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-3404
  • Fax: 815-941-2389
Mailing address:
  • Phone: 815-941-3404
  • Fax: 815-941-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE L PRUIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-941-3113