Healthcare Provider Details

I. General information

NPI: 1174583660
Provider Name (Legal Business Name): CHILDREN'S HOME ASSOCIATION OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 NORTH KNOXVILLE AVE
PEORIA IL
61603
US

IV. Provider business mailing address

2130 NORTH KNOXVILLE AVE
PEORIA IL
61603
US

V. Phone/Fax

Practice location:
  • Phone: 309-685-1047
  • Fax: 309-687-7299
Mailing address:
  • Phone: 309-685-1047
  • Fax: 309-687-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE SIEBERT
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 309-687-7440