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General NPI Number Information
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NPI Number | 1992155766
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Entity Type | Organization
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Legal Business Name | COUNTY OF WINNEBAGO
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 404 ELM ST
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City | ROCKFORD
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State | IL
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Zip | 61101-1239
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Country | US
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Telephone | 815-921-9200
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Fax | 815-877-8304
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Provider Business Mailing Address
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Address Line | 4401 N MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61103-1277
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Country | US
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Telephone | 815-921-9200
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Fax | 815-877-8304
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | MONICA PLYMALE
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Credential | LNHA
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Telephone | 815-921-9200
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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 | 5611
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License Number State | IL
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