Provider Demographics
NPI:1821001595
Name:HENDERSON COUNTY
Entity Type:Organization
Organization Name:HENDERSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-627-2812
Mailing Address - Street 1:208 WEST ELM STREET
Mailing Address - Street 2:P O BOX 220
Mailing Address - City:GLADSTONE
Mailing Address - State:IL
Mailing Address - Zip Code:61437-0220
Mailing Address - Country:US
Mailing Address - Phone:309-627-2812
Mailing Address - Fax:309-627-2305
Practice Address - Street 1:208 WEST ELM STREET
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:IL
Practice Address - Zip Code:61437-0220
Practice Address - Country:US
Practice Address - Phone:309-627-2812
Practice Address - Fax:309-627-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001502251E00000X, 261QP0905X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210000071001Medicaid
IL=========Medicaid
IL210000071001Medicaid