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General NPI Number Information
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NPI Number | 1760157838
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Entity Type | Organization
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Legal Business Name | CUNNINGHAM CHILDREN'S HOME OF URBANA, IL
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 1204 N DIVISION AVE
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City | URBANA
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State | IL
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Zip | 61801-1870
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Country | US
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Telephone | 217-337-9057
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Fax | 217-367-5910
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Provider Business Mailing Address
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Address Line | 1301 N CUNNINGHAM AVE
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City | URBANA
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State | IL
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Zip | 61802-1830
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Country | US
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Telephone | 217-367-3728
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Fax | 217-367-2896
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Authorized Official
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Title or Position | DIRECTOR OF QUALITY IMPROVEMENT
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Name | SHAWN SUZETTE PETERSON
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Credential |
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Telephone | 217-367-3728
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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