Provider Demographics
NPI:1972662658
Name:HENDERSON COUNTY RURAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HENDERSON COUNTY RURAL HEALTH CENTER, INC.
Other - Org Name:EAGLE VIEW COMMUNITY HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:COURSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-867-2202
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:STRONGHURST
Mailing Address - State:IL
Mailing Address - Zip Code:61480-0240
Mailing Address - Country:US
Mailing Address - Phone:309-924-1381
Mailing Address - Fax:309-924-1389
Practice Address - Street 1:101 SOUTH DIVISION
Practice Address - Street 2:
Practice Address - City:STRONGHURST
Practice Address - State:IL
Practice Address - Zip Code:61480
Practice Address - Country:US
Practice Address - Phone:309-924-1381
Practice Address - Fax:309-924-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0522557Medicaid
IL0522557Medicaid