MEDICARE: MENARD COUNTY HEALTH DEPARTMENT

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	251E00000X	Home Health Agency	1002096	IL
2	251E00000X	Home Health Agency	147070	IL

General Provider Information

NPI Number	:	1295704021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENARD COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	1120 N 4TH
Second Line	:	SUITE A
City	:	PETERSBURG
State	:	IL
Zip	:	62675
Country	:	US
Telephone Number	:	217-632-2984
Fax Number	:	217-632-3675

Provider Business Practice Location Address
First Line	:	1120 N 4TH
Second Line	:	SUITE A
City	:	PETERSBURG
State	:	IL
Zip	:	62675
Country	:	US
Telephone Number	:	217-632-2984
Fax Number	:	217-632-3675

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHERYL LEE
Credential	:	M.S.
Telephone Number	:	217-632-2984

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	01/09/2014

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Directions to “MENARD COUNTY HEALTH DEPARTMENT ” Practice Location

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