Healthcare Provider Details

I. General information

NPI: 1932372018
Provider Name (Legal Business Name): LIVINGSTON CO PUBLIC HLTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E TORRANCE
PONTIAC IL
61764-0650
US

IV. Provider business mailing address

P O BOX 650 310 E TORRANCE
PONTIAC IL
61764-0650
US

V. Phone/Fax

Practice location:
  • Phone: 815-844-7174
  • Fax: 815-842-1063
Mailing address:
  • Phone: 815-844-7174
  • Fax: 815-842-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALINDA HILLMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-844-7174