Provider Demographics
NPI:1245049501
Name:COUNTY OF HENRY
Entity type:Organization
Organization Name:COUNTY OF HENRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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:309-852-5272
Mailing Address - Fax:309-854-5575
Practice Address - Street 1:120 E COURT ST
Practice Address - Street 2:
Practice Address - City:TOULON
Practice Address - State:IL
Practice Address - Zip Code:61483-5388
Practice Address - Country:US
Practice Address - Phone:309-852-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF HENRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health