Provider Demographics
NPI:1366694317
Name:LAWRENCE COMMUNITY HEALTHCARE CENTER
Entity Type:Organization
Organization Name:LAWRENCE COMMUNITY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-945-2091
Mailing Address - Street 1:900 CORPORATION LINE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:62417-2206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 CORPORATION LINE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:IL
Practice Address - Zip Code:62417-2206
Practice Address - Country:US
Practice Address - Phone:618-945-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0045617332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========001Medicaid