Provider Demographics
NPI:1669698452
Name:JCH DIAYSIS CENTER, LLC
Entity type:Organization
Organization Name:JCH DIAYSIS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENU CYCLE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-8400
Mailing Address - Street 1:917 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2344
Mailing Address - Country:US
Mailing Address - Phone:618-498-6402
Mailing Address - Fax:
Practice Address - Street 1:917 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2344
Practice Address - Country:US
Practice Address - Phone:618-498-6402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLESSING HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50353OtherBLUE CROSS
IL50353OtherBLUE CROSS