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General NPI Number Information
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NPI Number | 1184449423
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN IL COMMUNITY ACTION AGENCY
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 27 S STATE AVE STE 102
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City | FREEPORT
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State | IL
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Zip | 61032-4210
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Country | US
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Telephone | 815-656-2669
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Fax | 815-232-3143
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Provider Business Mailing Address
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Address Line | 27 S STATE AVE STE 102
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City | FREEPORT
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State | IL
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Zip | 61032-4210
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Country | US
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Telephone | 815-656-2669
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Fax | 815-232-3143
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELISHA WALKER
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Credential |
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Telephone | 815-656-2669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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