Provider Demographics
NPI:1639461338
Name:VERMILION COUNTY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VERMILION COUNTY HEALTHCARE, INC.
Other - Org Name:VERMILION COUNTY MENTAL HEALTH CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAN ASSISTANT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLYCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:217-446-1100
Mailing Address - Street 1:715 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3795
Mailing Address - Country:US
Mailing Address - Phone:217-446-1100
Mailing Address - Fax:217-446-1101
Practice Address - Street 1:715 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3795
Practice Address - Country:US
Practice Address - Phone:217-446-1100
Practice Address - Fax:217-446-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002684261QP2300X
IL036103275261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3416295686183230Medicaid