=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801067186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACOUPIN COUNTY HOUSING AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 W MAIN ST
-----------------------------------------------------
City | CARLINVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62626-9202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-854-8142
-----------------------------------------------------
Fax | 217-854-9600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 662
-----------------------------------------------------
City | CARLINVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62626-0662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-854-8142
-----------------------------------------------------
Fax | 217-854-9600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. MARGARET A BARKLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-854-8606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 001
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------