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General NPI Number Information
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NPI Number | 1134552870
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOME ASSOCIATION OF ILLINOIS
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE #412A
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City | PEORIA
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State | IL
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Zip | 61614
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Country | US
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Telephone | 309-685-4017
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61603-2460
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MS. JULIE SIEBERT
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Credential |
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Telephone | 309-685-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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