Provider Demographics
NPI:1952463705
Name:COUNTY OF CARROLL
Entity Type:Organization
Organization Name:COUNTY OF CARROLL
Other - Org Name:CARROLL COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-244-8855
Mailing Address - Street 1:822 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-1243
Mailing Address - Country:US
Mailing Address - Phone:815-244-8855
Mailing Address - Fax:815-244-5010
Practice Address - Street 1:822 S MILL ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1243
Practice Address - Country:US
Practice Address - Phone:815-244-8855
Practice Address - Fax:815-244-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212652Medicare ID - Type Unspecified