Provider Demographics
NPI:1477686780
Name:GRUNDY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GRUNDY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-941-3113
Mailing Address - Street 1:1320 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2426
Mailing Address - Country:US
Mailing Address - Phone:815-941-3404
Mailing Address - Fax:815-941-2389
Practice Address - Street 1:1320 UNION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2426
Practice Address - Country:US
Practice Address - Phone:815-941-3404
Practice Address - Fax:815-941-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205532Medicare UPIN
ILC49401Medicare UPIN
IL205614Medicare UPIN