Provider Demographics
NPI:1649270729
Name:JERSEY COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:JERSEY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-498-9565
Mailing Address - Street 1:1307 STATE HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2396
Mailing Address - Country:US
Mailing Address - Phone:618-498-9565
Mailing Address - Fax:618-498-6291
Practice Address - Street 1:1307 STATE HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052
Practice Address - Country:US
Practice Address - Phone:618-498-9565
Practice Address - Fax:618-498-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QH0100X
IL1001577251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10906700OtherLOCAL HEALTH DEPARTMENT
IL1001577Medicare ID - Type UnspecifiedSTATE OF ILLINOIS LICENSE
IL10906700OtherLOCAL HEALTH DEPARTMENT