Healthcare Provider Details

I. General information

NPI: 1881630689
Provider Name (Legal Business Name): HUMAN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 NE JEFFERSON
PEORIA IL
61603
US

IV. Provider business mailing address

PO BOX 1346
PEORIA IL
61654-1346
US

V. Phone/Fax

Practice location:
  • Phone: 309-671-8000
  • Fax: 309-671-4695
Mailing address:
  • Phone: 309-671-8000
  • Fax: 309-671-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL KENNEDY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 309-671-8005