Healthcare Provider Details

I. General information

NPI: 1083527303
Provider Name (Legal Business Name): LAFAYETTEMED COMMUNITY HEALTH CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 SUN RIDGE DR
BOURBONNAIS IL
60914-9644
US

IV. Provider business mailing address

1563 SUN RIDGE DR
BOURBONNAIS IL
60914-9644
US

V. Phone/Fax

Practice location:
  • Phone: 815-908-9685
  • Fax:
Mailing address:
  • Phone: 815-908-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: K-SHAYLA LAFAYETTE
Title or Position: NURSE PRACTITIONER/CEO
Credential: NP
Phone: 815-908-9685