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NPI Code Detail

MEDICARE: TRANSITIONS OF WESTERN ILLINOIS INC.

MEDICARE: TRANSITIONS OF WESTERN ILLINOIS INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency04134IL
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1194784819
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRANSITIONS OF WESTERN ILLINOIS INC.
Provider Business Mailing Address
First Line : 4409 MAINE ST
Second Line : PO BOX 3646
City : QUINCY
State : IL
Zip : 62305-5849
Country : US
Telephone Number : 217-223-0413
Fax Number : 214-223-0461
Provider Business Practice Location Address
First Line : 4409 MAINE ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-5849
Country : US
Telephone Number : 217-223-0413
Fax Number : 217-223-0461
Authorized Official
Title or Position : EXEC DIRECTOR
Name : MR. MARK SCHMITZ
Credential :
Telephone Number : 217-223-0413
Provider Enumeration Date : 03/21/2006
Last Update Date : 04/12/2018

Similar Medicare Providers

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1912001546 — JARRED BRECK MAUCK BA,MHP
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1487758942 — JEANETTE MARIE OGLESBY EDWARDS QMHP, MA
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Directions to “TRANSITIONS OF WESTERN ILLINOIS INC. ” Practice Location

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