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Organization
CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Active
Organization
CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERIC KIMLER (EXECUTIVE DIRECTOR)
(309) 431-5880
Entity
Organization
Contact information
Practice address
120 NE GLEN OAK AVE STE 201, PEORIA, IL 61603-4315
(309) 431-5880
Mailing address
PO BOX 5022, PEORIA, IL 61601-5022
(309) 431-5880
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
363LC1500X
Community Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/23/2026
Last updated
01/23/2026
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