1639461338 NPI number — VERMILION COUNTY HEALTHCARE, INC.

Table of content: (NPI 1639461338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639461338 NPI number — VERMILION COUNTY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERMILION COUNTY HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VERMILION COUNTY MENTAL HEALTH CENTER, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639461338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 W FAIRCHILD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61832-3795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-446-1100
Provider Business Mailing Address Fax Number:
217-446-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 W FAIRCHILD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-3795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-446-1100
Provider Business Practice Location Address Fax Number:
217-446-1101
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOLYCROSS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PHYSICAN ASSISTANT/CEO
Authorized Official Telephone Number:
217-446-1100

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  085002684 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 036103275 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3416295686183230 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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