# ILLINOIS VETERANS HOME AT LASALLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942367453
- **Authorized official:** JOHN G. KOEHLER LNHA (ADMINISTRATOR)
- **Authorized official phone:** (815) 223-0303

## Contact information

- **Practice address:** 1015 OCONOR AVE, LA SALLE, IL 61301-1216
- **Practice address phone:** (815) 223-0303
- **Practice address fax:** (815) 223-5815
- **Mailing address:** 1015 OCONOR AVE, LA SALLE, IL 61301-1216
- **Mailing address phone:** (217) 222-9487
- **Mailing address fax:** (217) 222-8578

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 44115 | IL | — |
| 320700000X | Physical Disabilities Residential Treatment Facility | 44115 | IL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 05/24/2013