Provider Demographics
NPI:1174541015
Name:LASALLE COUNTY BOARD OFFICE
Entity type:Organization
Organization Name:LASALLE COUNTY BOARD OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CSERNUS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NURSING HOM
Authorized Official - Phone:815-433-0476
Mailing Address - Street 1:1380 N 27TH RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9732
Mailing Address - Country:US
Mailing Address - Phone:815-433-0476
Mailing Address - Fax:815-434-7141
Practice Address - Street 1:1380 N 27TH RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9732
Practice Address - Country:US
Practice Address - Phone:815-433-0476
Practice Address - Fax:815-434-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000010637313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility