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General NPI Number Information
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NPI Number | 1932058963
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLINOIS FRIENDS OF PWA, INC.
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 311 E MAIN ST STE 409
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City | GALESBURG
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State | IL
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Zip | 61401-4867
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Country | US
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Telephone | 309-431-5880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5022
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City | PEORIA
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State | IL
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Zip | 61601-5022
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Country | US
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Telephone | 309-431-5880
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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 | DERIC KIMLER
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Credential |
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Telephone | 309-431-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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