CHILDREN'S HOME ASSOCIATION OF ILLINOIS NPI 1932633427

NPI Information

NPI: 1932633427
Provider Name: CHILDREN'S HOME ASSOCIATION OF ILLINOIS
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
404 NE MADISON AVE
PEORIA, IL
ZIP 61603
Phone: (309) 685-1047
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CHILDREN'S HOME ASSOCIATION OF ILLINOIS is a rehabilitation and substance use disorder clinic center in Peoria, IL. CHILDREN'S HOME ASSOCIATION OF ILLINOIS NPI is 1932633427. The provider is registered as an organization entity type.

The provider's business location address is:

404 NE MADISON AVE
PEORIA, IL
ZIP 61603-720
Phone: (309) 685-1047
Fax: (309) 687-7299

The provider's authorized official is Matt George .
The authorized official title is Ceo and has the following contact phone number (390) 685-1047.

The enumeration date for this NPI number is 4/12/2017 and was last updated on 4/16/2018.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2B05-IPI-130	MEDICAID	ILLINOIS
2	A-6162-0002-A	MEDICAID	ILLINOIS

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: 4/28/2024

NPI Synchronization or Removal

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