Provider Demographics
NPI:1336689322
Name:ST. JOHN'S LUTHERAN CHURCH, INC.
Entity Type:Organization
Organization Name:ST. JOHN'S LUTHERAN CHURCH, INC.
Other - Org Name:THE FRIENDSHIP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-369-4035
Mailing Address - Street 1:311 N. LAKE R. P. O BOX 172
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-8712
Mailing Address - Country:US
Mailing Address - Phone:815-369-2690
Mailing Address - Fax:815-369-2535
Practice Address - Street 1:311 N. LAKE RD.
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-8712
Practice Address - Country:US
Practice Address - Phone:815-369-2690
Practice Address - Fax:815-369-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care