Healthcare Provider Details

I. General information

NPI: 1740533900
Provider Name (Legal Business Name): CHILDREN'S HOME ASSOCIATION OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 W PLANK RD
PEORIA IL
61604-5252
US

IV. Provider business mailing address

7225 W PLANK RD
PEORIA IL
61604-5252
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2B05-IPI-130
License Number StateIL
# 2
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