Healthcare Provider Details

I. General information

NPI: 1033460498
Provider Name (Legal Business Name): CHAMPAIGN TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S COUNTRY FAIR DR STE C
CHAMPAIGN IL
61821-3064
US

IV. Provider business mailing address

106 S COUNTRY FAIR DR SUITE C
CHAMPAIGN IL
61821-3063
US

V. Phone/Fax

Practice location:
  • Phone: 217-373-8200
  • Fax:
Mailing address:
  • Phone: 217-373-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRUCE JARVIE
Title or Position: VP, TREASURER
Credential:
Phone: 214-379-3300