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Organization

JAMIESON COMMUNITY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NANCY MOWEN (EXECUTIVE DIRECTOR)
(309) 734-4251
Entity
Organization

Contact information

Practice address
1025 S 2ND ST, MONMOUTH, IL 61462-2715
(309) 734-4251
Mailing address
1025 S 2ND ST, PO BOX 495, MONMOUTH, IL 61462-2715
(309) 734-4251

Taxonomy

Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
187-26-2017
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20150720755779
IMPACT - ILLINOIS PROVIDER ENROLLMENT SYSTEM
IL
Enumeration date
05/11/2017
Last updated
05/11/2017
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