Healthcare Provider Details

I. General information

NPI: 1306990601
Provider Name (Legal Business Name): SHAMROCK SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2157
US

IV. Provider business mailing address

PO BOX 2369
MOUNT VERNON IL
62864-0046
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-2169
  • Fax: 618-242-9770
Mailing address:
  • Phone: 618-244-7701
  • Fax: 618-244-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number94S227
License Number StateIL

VIII. Authorized Official

Name: BRIDGET P MCDONAGH
Title or Position: PARTNER
Credential:
Phone: 618-244-7701