Organization
HUMAN SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED NIRDE (PRESIDENT/CEO)
(309) 671-8000
Entity
Organization
Contact information
Practice address
405 NE PERRY AVE, PEORIA, IL 61603-3629
(309) 671-8005
Mailing address
PO BOX 1346, 600 FAYETTE, PEORIA, IL 61654-1346
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041
—
IL
Enumeration date
07/28/2010
Last updated
07/28/2010
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