Healthcare Provider Details

I. General information

NPI: 1043936438
Provider Name (Legal Business Name): PROMISE HEALTHCARE NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 S NEIL ST
CHAMPAIGN IL
61820-5205
US

IV. Provider business mailing address

819 BLOOMINGTON RD
CHAMPAIGN IL
61820-2101
US

V. Phone/Fax

Practice location:
  • Phone: 217-356-1558
  • Fax:
Mailing address:
  • Phone: 217-356-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: APRIL ARRASMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 217-403-5403