Provider Demographics
NPI:1164820999
Name:COUNTY OF HENRY
Entity Type:Organization
Organization Name:COUNTY OF HENRY
Other - Org Name:HENRY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-852-0197
Mailing Address - Street 1:4424 US HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-8319
Mailing Address - Country:US
Mailing Address - Phone:309-852-0197
Mailing Address - Fax:309-852-0595
Practice Address - Street 1:4424 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-8319
Practice Address - Country:US
Practice Address - Phone:309-852-0197
Practice Address - Fax:309-852-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2813OtherPTAN