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MONROE COUNTY NPI 1457500621


NPI Information

NPI: 1457500621
Provider Name: MONROE COUNTY

Doing Business As: MAGNOLIA TERRACE

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 14D2221330

Address:
623 HAMACHER STREET
WATERLOO, IL
ZIP 62298
Phone: (618) 939-0500
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MONROE COUNTY is an assisted living facility in Waterloo, IL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. MONROE COUNTY NPI is 1457500621. The provider is registered as an organization entity type.
The provider Is Doing Business As Magnolia Terrace.

The provider's business location address is:

623 HAMACHER STREET
WATERLOO, IL
ZIP 62298-598
Phone: (618) 939-0500
Fax: (618) 939-4906

The provider's authorized official is Kim Lee Keckritz .
The authorized official title is Administrator and has the following contact phone number (618) 939-3488.

The CLIA number assigned to this NPI record is 14D2221330 - other - supportive living fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/12/2008 and was last updated on 6/25/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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