Healthcare Provider Details

I. General information

NPI: 1235455130
Provider Name (Legal Business Name): COMMUNITY HEALTH IMPROVEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BROADWAY AVENUE EAST SUITE 39
MATTOON IL
61938-4662
US

IV. Provider business mailing address

2905 NORTH MAIN STREET
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-234-3091
  • Fax: 217-234-3094
Mailing address:
  • Phone: 217-877-9117
  • Fax: 217-877-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BARBARA B DUNN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 217-877-6111