Provider Demographics
NPI:1326035304
Name:COUNTY OF KNOX
Entity Type:Organization
Organization Name:COUNTY OF KNOX
Other - Org Name:KNOX COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MINES
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:309-289-2338
Mailing Address - Street 1:800 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61448-1096
Mailing Address - Country:US
Mailing Address - Phone:309-289-2338
Mailing Address - Fax:309-289-8255
Practice Address - Street 1:800 N MARKET ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IL
Practice Address - Zip Code:61448-1096
Practice Address - Country:US
Practice Address - Phone:309-289-2338
Practice Address - Fax:309-289-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0010561314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid