Healthcare Provider Details

I. General information

NPI: 1043988512
Provider Name (Legal Business Name): PREFERRED FAMILY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 09/02/2025
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 YORK ST RM 212
QUINCY IL
62301-3919
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6277
  • Fax: 217-224-4329
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARK CONOVER
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 573-603-1460