Organization
ILLINOIS VETERANS HOME AT LASALLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. KOEHLER LNHA (ADMINISTRATOR)
(815) 223-0303
Entity
Organization
Contact information
Practice address
1015 OCONOR AVE, LA SALLE, IL 61301-1216
(815) 223-0303
(815) 223-5815
Mailing address
1015 OCONOR AVE, LA SALLE, IL 61301-1216
(217) 222-9487
(217) 222-8578
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
44115
IL
320700000X
Physical Disabilities Residential Treatment Facility
Primary
44115
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05032039
BCBS
—
Enumeration date
01/03/2007
Last updated
05/24/2013
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