MEDICARE: DECATUR MACON COUNTY OPPORTUNITY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1245621184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR MACON COUNTY OPPORTUNITY CORPORATION

Provider Business Mailing Address
First Line	:	1122 E MARIETTA ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-1324
Country	:	US
Telephone Number	:	217-428-0155
Fax Number	:	217-428-0169

Provider Business Practice Location Address
First Line	:	1122 E MARIETTA ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-1324
Country	:	US
Telephone Number	:	217-428-0155
Fax Number	:	217-428-0169

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GAIL EVANS
Credential	:
Telephone Number	:	217-428-0155

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	02/13/2015

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