Provider Demographics
NPI:1891795837
Name:COUNTY OF MCHENRY ILLINOIS
Entity Type:Organization
Organization Name:COUNTY OF MCHENRY ILLINOIS
Other - Org Name:VALLEY HI NURSING HOME FOR MCHENRY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANNARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:815-338-0312
Mailing Address - Street 1:2406 HARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-9763
Mailing Address - Country:US
Mailing Address - Phone:815-338-0312
Mailing Address - Fax:815-338-0458
Practice Address - Street 1:2406 HARTLAND RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-9763
Practice Address - Country:US
Practice Address - Phone:815-338-0312
Practice Address - Fax:815-338-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046821314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
145652Medicare UPIN