Healthcare Provider Details

I. General information

NPI: 1760562961
Provider Name (Legal Business Name): CENTER FOR YOUR HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N LINCOLN ST
PHILO IL
61864-9653
US

IV. Provider business mailing address

501 N LINCOLN ST
PHILO IL
61864
US

V. Phone/Fax

Practice location:
  • Phone: 217-684-2419
  • Fax: 217-684-2356
Mailing address:
  • Phone: 217-684-2419
  • Fax: 217-684-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN K MANTELL
Title or Position: PHYSICIAN
Credential: MD
Phone: 217-684-2419