Healthcare Provider Details

I. General information

NPI: 1154376069
Provider Name (Legal Business Name): COUNTY OF LAWRENCE HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 JAMES ST
LAWRENCEVILLE IL
62439-2027
US

IV. Provider business mailing address

PO BOX 516
LAWRENCEVILLE IL
62439-0516
US

V. Phone/Fax

Practice location:
  • Phone: 618-943-3302
  • Fax: 618-943-7396
Mailing address:
  • Phone: 618-943-4663
  • Fax: 618-943-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001833
License Number StateIL

VIII. Authorized Official

Name: TINA LYDEN
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 618-943-3302