Organization
COUNTY OF JO DAVIESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH KANE MPA (ADMINISTRATOR)
(815) 777-0263
Entity
Organization
Contact information
Practice address
9483 W US 20, GALENA, IL 61036-9182
(815) 777-1040
(815) 777-0292
Mailing address
9483 W US 20, P.O. BOX 318, GALENA, IL 61036-9182
(815) 777-1040
(815) 777-0292
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1494045
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9646
BLUE CROSS BLUE SHIELD
IL
01
—
L031253
TRICARE
IL
Enumeration date
08/09/2005
Last updated
05/21/2015
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