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General NPI Number Information
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NPI Number | 1891795837
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Entity Type | Organization
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Legal Business Name | COUNTY OF MCHENRY ILLINOIS
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 2406 HARTLAND RD
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City | WOODSTOCK
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State | IL
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Zip | 60098-9763
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Country | US
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Telephone | 815-338-0312
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Fax | 815-338-0458
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Provider Business Mailing Address
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Address Line | 2406 HARTLAND RD
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City | WOODSTOCK
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State | IL
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Zip | 60098-9763
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Country | US
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Telephone | 815-338-0312
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Fax | 815-338-0458
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MR. THOMAS J ANNARELLA
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Credential | L.N.H.A.
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Telephone | 815-338-0312
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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 | 0046821
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License Number State | IL
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