Organization
CHILDREN'S HOME ASSOCIATION OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON MILLER (BILLING ANALYST)
(309) 687-7241
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE STE 412A, PEORIA, IL 61614-5021
(309) 687-7241
Mailing address
2130 N KNOXVILLE AVE, PEORIA, IL 61603-2460
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2B05-IPI-130
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2B05-IPI-130
—
IL
Enumeration date
09/01/2017
Last updated
09/01/2017
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