Healthcare Provider Details

I. General information

NPI: 1063446938
Provider Name (Legal Business Name): CUMBERLAND COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. INDIANA ST.
TOLEDO IL
62468-0130
US

IV. Provider business mailing address

P.O. BOX 130
TOLEDO IL
62468-0130
US

V. Phone/Fax

Practice location:
  • Phone: 217-849-3211
  • Fax: 217-849-3121
Mailing address:
  • Phone: 217-849-3211
  • Fax: 217-849-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005982
License Number StateIL

VIII. Authorized Official

Name: CYNTHIA DIANE HANLEY
Title or Position: HR MANAGER
Credential:
Phone: 217-849-3211