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General NPI Number Information
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NPI Number | 1891944393
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Entity Type | Organization
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Legal Business Name | HENDERSON COUNTY
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 208 WEST ELM STREET
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City | GLADSTONE
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State | IL
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Zip | 61437
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Country | UM
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Telephone | 309-627-2812
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Fax | 309-627-2793
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Provider Business Mailing Address
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Address Line | P O BOX 220 208 WEST ELM STREET
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City | GLADSTONE
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State | IL
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Zip | 61437
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Country | UM
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Telephone | 309-627-2812
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Fax | 309-627-2793
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANA SEITZ
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Credential |
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Telephone | 309-627-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1001502
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License Number State | IL
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