Basic Information
| Provider Information | |||||||||
| NPI: | 1811070014 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF KENDALL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | KENDALL COUNTY HEALTH DEPARTMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 811 W JOHN ST | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605609249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305530167 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 W JOHN ST | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305539100 | ||||||||
| FaxNumber: | 6305530167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TOKARS | ||||||||
| AuthorizedOfficialFirstName: | AMAAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR/PUBLIC HLTH ADMI | ||||||||
| AuthorizedOfficialTelephone: | 6305539100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | A-0282-0002-A | IL | N | Agencies | Public Health or Welfare | 261QM0801X | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 324500000X | IL | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.