Provider Demographics
NPI:1225038169
Name:COUNTY OF GREENE
Entity Type:Organization
Organization Name:COUNTY OF GREENE
Other - Org Name:GREENE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LEHP
Authorized Official - Phone:217-942-6961
Mailing Address - Street 1:310 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1325
Mailing Address - Country:US
Mailing Address - Phone:217-942-6961
Mailing Address - Fax:217-942-3904
Practice Address - Street 1:310 5TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1325
Practice Address - Country:US
Practice Address - Phone:217-942-6961
Practice Address - Fax:217-942-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001452251E00000X
251E00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9626OtherBC/BS OF ILLINOIS
IL147091Medicare ID - Type Unspecified
IL9626OtherBC/BS OF ILLINOIS