Provider Demographics
NPI:1174523914
Name:FAYETTE COUNTY
Entity type:Organization
Organization Name:FAYETTE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-1044
Mailing Address - Street 1:416 W EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-2706
Mailing Address - Country:US
Mailing Address - Phone:618-283-1044
Mailing Address - Fax:618-283-5038
Practice Address - Street 1:416 W EDWARDS ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-2706
Practice Address - Country:US
Practice Address - Phone:618-283-7262
Practice Address - Fax:618-283-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1863108251G00000X
IL1625062251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9819OtherBC/BS
IL136947OtherHEALTH LINK
IL50364OtherBC/BS HOSPICE
IL50364OtherBC/BS HOSPICE
IL141607Medicare Oscar/Certification
IL50364OtherBC/BS HOSPICE