Provider Demographics
NPI:1700814704
Name:CLINTON COUNTY
Entity Type:Organization
Organization Name:CLINTON COUNTY
Other - Org Name:CLINTON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-594-2723
Mailing Address - Street 1:930 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231
Mailing Address - Country:US
Mailing Address - Phone:618-594-2723
Mailing Address - Fax:618-594-5474
Practice Address - Street 1:930 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231
Practice Address - Country:US
Practice Address - Phone:618-594-2723
Practice Address - Fax:618-594-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL387450Medicare PIN