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General NPI Number Information
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NPI Number | 1497889554
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Entity Type | Organization
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Legal Business Name | COUNTY OF FULTON
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 625 EAST MONROE STREET
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City | CUBA
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State | IL
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Zip | 61427-0200
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Country | US
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Telephone | 309-785-5012
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Fax | 309-785-5376
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Provider Business Mailing Address
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Address Line | PO BOX 200 625 EAST MONROE STREET
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City | CUBA
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State | IL
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Zip | 61427-0200
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Country | US
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Telephone | 309-785-5012
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Fax | 309-785-5376
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARTHA J DANIELSON
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Credential | LNHA
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Telephone | 309-785-5012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0014290
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0014290
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License Number State | IL
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