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Organization
HUMAN SERVICE CENTER
Active
Organization
HUMAN SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KENNEDY (PRESIDENT/CEO)
(309) 671-8005
Entity
Organization
Contact information
Practice address
228 NE JEFFERSON, PEORIA, IL 61603
(309) 671-8000
(309) 671-4695
Mailing address
PO BOX 1346, PEORIA, IL 61654-1346
(309) 671-8000
(309) 671-4695
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060238
—
IL
05
—
036088236
—
IL
05
—
036094197
—
IL
01
—
580
BCBS
IL
Enumeration date
06/21/2006
Last updated
12/12/2017
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