Healthcare Provider Details

I. General information

NPI: 1831683382
Provider Name (Legal Business Name): CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N CUNNINGHAM AVE
URBANA IL
61802-1830
US

IV. Provider business mailing address

1301 N CUNNINGHAM AVE
URBANA IL
61802-1830
US

V. Phone/Fax

Practice location:
  • Phone: 217-367-3728
  • Fax: 217-367-2896
Mailing address:
  • Phone: 217-367-3728
  • Fax: 217-367-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAWN SUZETTE PETERSON
Title or Position: DIRECTOR OF QUALITY IMPROVEMENT
Credential:
Phone: 217-367-3728