Provider Demographics
NPI:1912944703
Name:HYGIENIC INSTITUTE FOR LASALLE, PERU AND OGLESBY
Entity Type:Organization
Organization Name:HYGIENIC INSTITUTE FOR LASALLE, PERU AND OGLESBY
Other - Org Name:HYGIENIC INSTITUTE COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:815-223-0196
Mailing Address - Street 1:2970 CHARTRES ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1097
Mailing Address - Country:US
Mailing Address - Phone:815-223-0196
Mailing Address - Fax:815-223-0358
Practice Address - Street 1:2970 CHARTRES ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1097
Practice Address - Country:US
Practice Address - Phone:815-223-0196
Practice Address - Fax:815-223-0358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IV HEALTH CORP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL004261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid
IL148977Medicare ID - Type Unspecified
IL=========004Medicaid