Provider Demographics
NPI:1164424487
Name:MONROE COUNTY
Entity Type:Organization
Organization Name:MONROE COUNTY
Other - Org Name:OAK HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KECKRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-939-3488
Mailing Address - Street 1:623 HAMACHER STREET
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1598
Mailing Address - Country:US
Mailing Address - Phone:618-939-3488
Mailing Address - Fax:618-939-5030
Practice Address - Street 1:623 HAMACHER STREET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1598
Practice Address - Country:US
Practice Address - Phone:618-939-3488
Practice Address - Fax:918-929-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145445Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL=========001Medicaid
IL=========002Medicaid
IL=========003Medicaid