Healthcare Provider Details

I. General information

NPI: 1982602330
Provider Name (Legal Business Name): CHAMPAIGN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTH ART BARTELL ROAD
URBANA IL
61802
US

IV. Provider business mailing address

500 SOUTH ART BARTELL ROAD
URBANA IL
61802
US

V. Phone/Fax

Practice location:
  • Phone: 217-384-3874
  • Fax: 217-337-0120
Mailing address:
  • Phone: 217-384-3784
  • Fax: 217-337-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0001636
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0001636
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number001636
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number001636
License Number StateIL

VIII. Authorized Official

Name: MRS. KAREN L NOFFKE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 217-693-5015