Provider Demographics
NPI:1073762290
Name:COUNTY OF LOGAN
Entity Type:Organization
Organization Name:COUNTY OF LOGAN
Other - Org Name:LOGAN COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING/ASSISTANT ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:217-735-2317
Mailing Address - Street 1:109 3RD ST
Mailing Address - Street 2:P.O. BOX 508
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2604
Mailing Address - Country:US
Mailing Address - Phone:217-735-2317
Mailing Address - Fax:217-732-6943
Practice Address - Street 1:109 3RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2604
Practice Address - Country:US
Practice Address - Phone:217-735-2317
Practice Address - Fax:217-732-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid