Provider Demographics
NPI:1700925930
Name:KANKAKEE COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:KANKAKEE COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAAFSMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:815-802-9393
Mailing Address - Street 1:2390 W STATION ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3000
Mailing Address - Country:US
Mailing Address - Phone:815-802-9392
Mailing Address - Fax:815-802-9391
Practice Address - Street 1:2390 W STATION ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3000
Practice Address - Country:US
Practice Address - Phone:815-802-9392
Practice Address - Fax:815-802-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366006594001Medicaid
IL3337000Medicare ID - Type Unspecified