Provider Demographics
NPI:1851394829
Name:COUNTY OF HENRY
Entity Type:Organization
Organization Name:COUNTY OF HENRY
Other - Org Name:FIRST CHOICE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFOLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-852-0197
Mailing Address - Street 1:110 N BURR BLVD
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2214
Mailing Address - Country:US
Mailing Address - Phone:309-852-0197
Mailing Address - Fax:098-545-5753
Practice Address - Street 1:110 N BURR BLVD
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2214
Practice Address - Country:US
Practice Address - Phone:309-852-0197
Practice Address - Fax:098-545-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDH1819OtherMEDICARE RR
IL241300OtherMEDICARE PART B
IL3721776OtherBCBS
ILDH1819OtherMEDICARE RR
IL147075Medicare Oscar/Certification