Healthcare Provider Details

I. General information

NPI: 1851394829
Provider Name (Legal Business Name): COUNTY OF HENRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N BURR BLVD
KEWANEE IL
61443-2214
US

IV. Provider business mailing address

110 N BURR BLVD
KEWANEE IL
61443-2214
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-0197
  • Fax: 98-545-5753
Mailing address:
  • Phone: 309-852-0197
  • Fax: 98-545-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TARA LAFOLLETTE
Title or Position: INSURANCE BILLING
Credential:
Phone: 309-852-0197