Provider Demographics
NPI:1437425378
Name:HENDERSON COUNTY
Entity Type:Organization
Organization Name:HENDERSON COUNTY
Other - Org Name:HENDERSON COUNTY HEALTH DEPARTMENT HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-627-2812
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:IL
Mailing Address - Zip Code:61437-0220
Mailing Address - Country:US
Mailing Address - Phone:309-627-2812
Mailing Address - Fax:309-627-2305
Practice Address - Street 1:208 W ELM ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:IL
Practice Address - Zip Code:61437-5028
Practice Address - Country:US
Practice Address - Phone:309-627-2812
Practice Address - Fax:309-627-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002640251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
141631Medicare UPIN