Provider Demographics
NPI:1598761033
Name:COUNTY OF MCDONOUGH MCDONOUGH COUNTY CLERK
Entity Type:Organization
Organization Name:COUNTY OF MCDONOUGH MCDONOUGH COUNTY CLERK
Other - Org Name:THE ELMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHRORIZED OFFICIAL
Authorized Official - Phone:309-837-5482
Mailing Address - Street 1:1212 MADELYN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-837-5482
Mailing Address - Fax:309-833-1054
Practice Address - Street 1:1212 MADELYN AVENUE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-837-5482
Practice Address - Fax:309-833-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0021568314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021568OtherPUBLIC HEALTH I.D. NUMBER
IL0021568OtherPUBLIC HEALTH I.D. NUMBER
IL0021568OtherPUBLIC HEALTH I.D. NUMBER