Provider Demographics
NPI:1255398517
Name:LIVINGSTON COUNTY
Entity type:Organization
Organization Name:LIVINGSTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, MCHES
Authorized Official - Phone:815-842-5908
Mailing Address - Street 1:310 E TORRANCE AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-2748
Mailing Address - Country:US
Mailing Address - Phone:815-844-7174
Mailing Address - Fax:815-842-1063
Practice Address - Street 1:310 E TORRANCE AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2748
Practice Address - Country:US
Practice Address - Phone:815-844-7174
Practice Address - Fax:815-842-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL329030Medicare PIN