Provider Demographics
NPI:1083799035
Name:CLAY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CLAY COUNTY HEALTH DEPARTMENT
Other - Org Name:CLAY HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-662-4406
Mailing Address - Street 1:601 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-2335
Mailing Address - Country:US
Mailing Address - Phone:618-662-4406
Mailing Address - Fax:618-662-2801
Practice Address - Street 1:601 E 12TH ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-2335
Practice Address - Country:US
Practice Address - Phone:618-662-4406
Practice Address - Fax:618-662-2801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1000157251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50257OtherBLUE CROSS/BLUESHIELD
IL50257OtherBLUE CROSS/BLUESHIELD
IL=========002Medicaid