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General NPI Number Information
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NPI Number | 1043851488
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Entity Type | Organization
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Legal Business Name | WEST CENTRAL ILLINOIS NUTRITION
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 639 YORK ST. ROOM 333
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City | QUINCY
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State | IL
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Zip | 62301
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Country | US
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Telephone | 217-592-3657
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Fax | 217-592-3761
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Provider Business Mailing Address
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Address Line | 639 YORK ST. ROOM 333
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City | QUINCY
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State | IL
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Zip | 62301
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Country | US
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Telephone | 217-592-3657
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Fax | 217-592-3761
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Authorized Official
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Title or Position | DIRECTOR
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Name | KIMBERLY J THOMPSON
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Credential | CDM/CFPP
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Telephone | 217-592-3653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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