Provider Demographics
NPI:1720734361
Name:ILLINOIS VALLEY ACCULABS LLC
Entity Type:Organization
Organization Name:ILLINOIS VALLEY ACCULABS LLC
Other - Org Name:ILLINOIS VALLEY ACCULABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:EHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-780-8134
Mailing Address - Street 1:2011 ROCK ST STE D2
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1392
Mailing Address - Country:US
Mailing Address - Phone:181-578-0813
Mailing Address - Fax:
Practice Address - Street 1:2011 ROCK ST STE D2
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1392
Practice Address - Country:US
Practice Address - Phone:815-780-8134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center