Healthcare Provider Details

I. General information

NPI: 1073643474
Provider Name (Legal Business Name): EPIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 W TOWNLINE RD
PEORIA IL
61615-1621
US

IV. Provider business mailing address

PO BOX 3418 1913 TOWNLINE ROAD
PEORIA IL
61612-3418
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-3800
  • Fax: 309-689-3613
Mailing address:
  • Phone: 309-691-3800
  • Fax: 309-689-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: JULIA KIM CORNWELL
Title or Position: CEO
Credential:
Phone: 309-691-3800