Provider Demographics
NPI:1972847507
Name:COUNTRY HEALTH, INC
Entity Type:Organization
Organization Name:COUNTRY HEALTH, INC
Other - Org Name:COUNTRY HEALTH CARE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:309-823-7135
Mailing Address - Street 1:115 W JEFFERSON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3946
Mailing Address - Country:US
Mailing Address - Phone:309-828-4361
Mailing Address - Fax:309-829-5477
Practice Address - Street 1:2304 COUNTRY ROAD 3000 NORTH
Practice Address - Street 2:
Practice Address - City:GIFFORD
Practice Address - State:IL
Practice Address - Zip Code:61847-9756
Practice Address - Country:US
Practice Address - Phone:217-568-7362
Practice Address - Fax:217-568-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies