Organization
HENDERSON COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA SEITZ (OFFICE MANAGER)
(309) 627-2812
Entity
Organization
Contact information
Practice address
208 WEST ELM STREET, GLADSTONE, IL 61437-0220
(309) 627-2812
(309) 627-2305
Mailing address
208 WEST ELM STREET, P O BOX 220, GLADSTONE, IL 61437-0220
(309) 627-2812
(309) 627-2305
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1001502
IL
251G00000X
Community Based Hospice Care Agency
—
—
261QP0905X
State or Local Public Health Clinic/Center
1001502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210000071001
—
IL
Enumeration date
08/14/2006
Last updated
02/20/2024
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