Healthcare Provider Details

I. General information

NPI: 1104261494
Provider Name (Legal Business Name): KENDALL COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

IV. Provider business mailing address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-9100
  • Fax: 630-553-0167
Mailing address:
  • Phone: 630-553-9100
  • Fax: 630-553-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number041151527
License Number StateIL

VIII. Authorized Official

Name: TOM THOMAS
Title or Position: OPERATIONS ADMINISTRATOR
Credential:
Phone: 630-553-8027