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CENTRAL ILLINOIS FRIENDS OF PWA INC. NPI 1447866900


NPI Information

NPI: 1447866900
Provider Name: CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 14D2045437

Address:
120 NE GLEN OAK AVE STE 201
PEORIA, IL
ZIP 61603
Phone: (309) 671-2144
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CENTRAL ILLINOIS FRIENDS OF PWA, INC. is a community behavioral health in Peoria, IL. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. CENTRAL ILLINOIS FRIENDS OF PWA, INC. NPI is 1447866900. The provider is registered as an organization entity type.

The provider's business location address is:

120 NE GLEN OAK AVE STE 201
PEORIA, IL
ZIP 61603-315
Phone: (309) 671-2144
Fax: (309) 671-5108

The provider's authorized official is Deric Kimler .
The authorized official title is Executive Director and has the following contact phone number (309) 671-2144.

The CLIA number assigned to this NPI record is 14D2045437 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/21/2020 and was last updated on 9/21/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251B00000XCase ManagementNo
2251K00000XPublic Health or WelfareNo
3251V00000XVoluntary or CharitableNo
4261Q00000XClinic/CenterNo
5251S00000XCommunity/Behavioral HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.