Organization
BOONE COUNTY COUNCIL ON AGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE FORTMANN (EXECUTIVE DIRECTOR)
(815) 544-9893
Entity
Organization
Contact information
Practice address
2141 HENRY LUCKOW LN, BELVIDERE, IL 61008-1700
(815) 544-9893
(815) 547-7373
Mailing address
2141 HENRY LUCKOW LN, BELVIDERE, IL 61008-1700
(815) 544-9893
(815) 547-7373
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
INH1001001
STATE OF ILLINOIS CCP CONTRACT
IL
Enumeration date
09/30/2013
Last updated
09/30/2013
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