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General NPI Number Information
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NPI Number | 1093241960
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Entity Type | Organization
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Legal Business Name | JAMIESON COMMUNITY CENTER
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 1025 S 2ND ST
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City | MONMOUTH
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State | IL
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Zip | 61462-2715
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Country | US
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Telephone | 309-734-4251
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 S 2ND ST PO BOX 495
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City | MONMOUTH
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State | IL
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Zip | 61462-2715
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Country | US
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Telephone | 309-734-4251
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | NANCY MOWEN
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Credential |
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Telephone | 309-734-4251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 187-26-2017
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License Number State | IL
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