Provider Demographics
NPI:1548335862
Name:COUNTY OF PIKE
Entity type:Organization
Organization Name:COUNTY OF PIKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:217-285-4407
Mailing Address - Street 1:606 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1308
Mailing Address - Country:US
Mailing Address - Phone:217-285-4407
Mailing Address - Fax:217-285-4639
Practice Address - Street 1:606 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1308
Practice Address - Country:US
Practice Address - Phone:217-285-4407
Practice Address - Fax:217-285-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002187163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-7065Medicare UPIN
IL14-7065Medicare UPIN