TAZWOOD MENTAL HEALTH CENTER, INC. (NPI# 1134464316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134464316 |
| Entity Type | Organization |
| Organization Name | TAZWOOD MENTAL HEALTH CENTER, INC. |
| Practice Address |
101 S. Major Street Eureka IL 61530 |
| Mailing Address |
3248 Vandever Ave Pekin IL 61554-6257 |
| Practice Telephone | 3096946462 |
| Practice Fax Number | 3093474264 |
| Mailing Telephone | 3093475522 |
| Mailing Fax Number | 3093474264 |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2018-07-12 |
| Authorized Official Name | MR. DAVID W. MINGUS (CEO) |
| Authorized Official Telephone | 3093475522 |
| Authorized Official Credential | LCPC, CRADC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629444070 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 210 W. Walnut Street, Canton, IL 61520-2444 | 2015-08-19 |
| 1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
| 1013186683 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1421 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1568631133 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1425 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| 1760958797 | Tazwood Mental Health Center, Inc. | Clinic/Center | 124 S Chicago St, Lincoln, IL 62656-2719 | 2018-10-17 |
| 1538540190 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 601 Taylor St, East Peoria, IL 61611 | 2015-06-09 |
| 1629247366 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1423 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1851417091 | Tazwood Mental Health Center, Inc. | Counselor | 3248 Vandever Ave, Pekin, IL 61554-6257 | 2007-03-21 |
| 1760508907 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | TAZWOOD MENTAL HEALTH CENTER, INC. | 3248 Vandever Ave, Pekin, IL 61554-6257 |
| Street Address |
101 S. MAJOR STREET |
| City | EUREKA |
| State | IL |
| Zip Code | 61530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508009234 | Woodford County | Substance Abuse Rehabilitation Facility | 105 E Court St, Eureka, IL 61530 | 2009-04-10 |
| 1609889914 | Apostolic Christian Home of Eureka | Skilled Nursing Facility | 610 W. Cruger St., Eureka, IL 61530 | 2006-08-15 |
| 1326003344 | Eric John Larson | Counselor | 109 E Eureka, Eureka, IL 61530 | 2006-04-20 |
| 1467789511 | Julie Tuttle | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61530 | 2009-11-11 |
| 1720073414 | Maple Lawn Health Center | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2005-09-19 |
| 1992158356 | Kendra Mickelson | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-07-20 |
| 1720439110 | Loft Rehabilitation and Nursing LLC | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-06-27 |
| 1841470374 | Maple Lawn Homes Inc. | Clinic/Center | 700 N Main St, Eureka, IL 61530-1085 | 2007-11-13 |
| 1093818767 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 501 W Center St, Eureka, IL 61530-1111 | 2006-09-07 |
| 1871911859 | Alan Stutzman | Pharmacist | 501 W Center St, Eureka, IL 61530-1111 | 2014-04-07 |
| Find all providers in zip 61530 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982923009 | Humboldt Fanilyservicecenter | Clinic/Center | 1802 California St, Eureka, CA 95501-2808 | 2010-05-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.