| Organization Name: | TAZWOOD MENTAL HEALTH CENTER, INC. |
| NPI Number: | 1083671127 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVE WALTER MINGUS (CEO) |
| Mailing Address: | 3248 Vandever Ave Pekin |
| State: | IL US |
| Postal Code: | 61554 |
| Phone Number: | 3093475522 |
| Fax Number: | 3093474264 |
| NPI Enumeration Date: | 05/01/2006 |
| NPI Last Update Date: | 12/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 04132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |