Healthcare Provider Details

I. General information

NPI: 1669383402
Provider Name (Legal Business Name): DEI GRACIA COMMUNITY HEALTH FOUNDATION NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N CUNNINGHAM AVE STE A
URBANA IL
61802-1746
US

IV. Provider business mailing address

909 N CUNNINGHAM AVE STE A
URBANA IL
61802-1746
US

V. Phone/Fax

Practice location:
  • Phone: 217-607-8110
  • Fax:
Mailing address:
  • Phone: 217-607-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NATHALIE ROSINE KORI NKENLIFACK MANHENKEU
Title or Position: DNP,FNP,PMHNP
Credential: APRN
Phone: 217-819-7328