Provider Demographics
NPI:1841431913
Name:HANCOCK COUNTY SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:HANCOCK COUNTY SUPPORTIVE LIVING
Other - Org Name:HICKORY GROVE APARTMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-357-6550
Mailing Address - Street 1:400 S ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321
Mailing Address - Country:US
Mailing Address - Phone:217-357-6550
Mailing Address - Fax:217-357-6562
Practice Address - Street 1:400 S ADAMS STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321
Practice Address - Country:US
Practice Address - Phone:217-357-6550
Practice Address - Fax:217-357-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility