Provider Demographics
NPI:1790785186
Name:COUNTY OF LOGAN
Entity Type:Organization
Organization Name:COUNTY OF LOGAN
Other - Org Name:HOME CARE OF CENTRAL ILLINOIS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-735-2317
Mailing Address - Street 1:109 3RD ST
Mailing Address - Street 2:P.O. BOX 508
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-0508
Mailing Address - Country:US
Mailing Address - Phone:217-735-2317
Mailing Address - Fax:217-732-6943
Practice Address - Street 1:109 3RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-0508
Practice Address - Country:US
Practice Address - Phone:217-735-2317
Practice Address - Fax:217-732-6943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOGAN COUNTY DEPARTMENT OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1001866251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL600002138OtherRAILROAD MEDICARE PROVIDE
IL382030OtherMEDICARE PART B PROVIDER
IL=========001Medicaid
IL14-7195Medicare ID - Type UnspecifiedHOME HEALTH AGENCY