Provider Demographics
NPI:1689141145
Name:EGYPTIAN HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:EGYPTIAN HEALTH DEPARTMENT
Other - Org Name:EGYPTIAN BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-273-3326
Mailing Address - Street 1:1412 US HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3766
Mailing Address - Country:US
Mailing Address - Phone:618-273-3326
Mailing Address - Fax:618-273-3585
Practice Address - Street 1:407 N BASIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9639
Practice Address - Country:US
Practice Address - Phone:618-273-3326
Practice Address - Fax:618-273-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04051Medicaid