Organization
CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN SUZETTE PETERSON (DIRECTOR OF QUALITY IMPROVEMENT)
(217) 367-3728
Entity
Organization
Contact information
Practice address
208 E WASHINGTON ST, URBANA, IL 61801-4227
(217) 367-3728
(217) 367-3728
Mailing address
1301 N CUNNINGHAM AVE, URBANA, IL 61802-1830
(217) 367-3728
(217) 367-2896
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37062521007
—
IL
Enumeration date
06/19/2018
Last updated
06/19/2018
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