Tax Exempt Corporation / Sole Proprietor Partnership / /
Country
United States / /
Currency
USD / /
Facility
IDPH’s Center / Trust Pharmacy / Clinic Name / /
IndustryTerm
health services / clinical services / local law / ambulatory care services / healthcare services / practice site / be spent providing clinical services / /
Organization
Center for Rural Health Illinois Department of Public Health / National Health Service Corps / federal government / IDPH’s Center for Rural Health / Illinois Department of Human Rights Number / office of Policy / What / Illinois Department of Public Health / Illinois Department of Revenue / Illinois Office / ILLINOIS NATIONAL HEALTH SERVICE / Center for Rural Health / Illinois Attorney General’s Office / Applicant Organization / /
Person
GRANT BUDGET / Grant Term / GRANT HISTORY / /
Position
Chief Officer / Dentist Physician / care physician / Deputy Director Date / Psychiatrist Physician / Director / Advanced Practice Nurse Physician / Physician Assistant Physician / Division Chief/Program Manager / certified nurse / nurse / physician / Representative / General / obstetrician /gynecologist / appropriate official / Secretary of State / Treasurer of the United States / Nurse Midwife / /
FOR IDPH Use Only Application No. _______________ Date Received ________________ ILLINOIS DEPARTMENT OF PUBLIC HEALTH