Organization Name: | CHILDREN'S HOME & AID SOCIETY OF IL |
NPI Number: | 1134311038 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TERRY J PEEK (REGIONAL EXECUTIVE VICE PRESIDENT) |
Mailing Address: | 2133 Johnson Rd Granite City |
State: | IL US |
Postal Code: | 620403986 |
Phone Number: | 6184528900 |
Fax Number: | 6184529062 |
NPI Enumeration Date: | 08/14/2007 |
NPI Last Update Date: | 08/14/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 004236-11 |
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: |