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NPI Code Detail

MEDICARE: COUNTY OF KNOX

MEDICARE: COUNTY OF KNOX
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
1314000000XSkilled Nursing Facility0010561IL

General Provider Information

NPI Number : 1326035304
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF KNOX
Provider Business Mailing Address
First Line : 800 N MARKET ST
Second Line :
City : KNOXVILLE
State : IL
Zip : 61448-1096
Country : US
Telephone Number : 309-289-2338
Fax Number : 309-289-8255
Provider Business Practice Location Address
First Line : 800 N MARKET ST
Second Line :
City : KNOXVILLE
State : IL
Zip : 61448-1096
Country : US
Telephone Number : 309-289-2338
Fax Number : 309-289-8255
Authorized Official
Title or Position : ADMINISTRATOR
Name : JODI ANN MINES
Credential : LNHA
Telephone Number : 309-289-2338
Provider Enumeration Date : 10/04/2005
Last Update Date : 02/13/2023

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Directions to “COUNTY OF KNOX ” Practice Location

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