Provider Demographics
NPI:1811441371
Name:HUMAN RESOURCES CENTER OF EDGAR AND CLARK COUNTIES
Entity type:Organization
Organization Name:HUMAN RESOURCES CENTER OF EDGAR AND CLARK COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-465-4118
Mailing Address - Street 1:118 E COURT ST
Mailing Address - Street 2:P. O. BOX 1118
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2210
Mailing Address - Country:US
Mailing Address - Phone:217-465-4118
Mailing Address - Fax:217-463-1899
Practice Address - Street 1:118 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2210
Practice Address - Country:US
Practice Address - Phone:217-465-4118
Practice Address - Fax:217-463-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1407014376Medicaid
IL1790942761Medicaid
IL1104088624Medicaid
IL1205883428Medicaid
IL1184881773Medicaid
IL1437316023Medicaid