CENTRAL ILLINOIS FRIENDS OF PWA, INC.


Address: 120 Ne Glen Oak Ave Ste 201, Peoria, IL 61603-4315
Phone: 3096712144

CENTRAL ILLINOIS FRIENDS OF PWA, INC. (NPI# 1447866900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1447866900
Entity Type Organization
Organization Name CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Practice Address 120 Ne Glen Oak Ave Ste 201
Peoria
IL 61603-4315
Mailing Address Po Box 5022
Peoria
IL 61601-5022
Practice Telephone 3096712144
Practice Fax Number 3096715108
Mailing Telephone 3096712144
Mailing Fax Number 3096715108
Enumeration Date 2020-09-21
Last Update Date 2020-09-21
Authorized Official Name DERIC KIMLER (EXECUTIVE DIRECTOR)
Authorized Official Telephone 3096712144
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 251B00000X Case Management Agencies
N 251K00000X Public Health or Welfare Agencies
N 251V00000X Voluntary or Charitable Agencies
N 261Q00000X Clinic/Center Ambulatory Health Care Facilities
Y 251S00000X Community/Behavioral Health Agencies

Other Provider/Organization Names

Other Name Type Code
Central Illinois Friends Doing Business As Name - Organization

Office Location

Street Address 120 NE GLEN OAK AVE STE 201
City PEORIA
State IL
Zip Code 61603-4315

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598362980 Courtney Klein Nurse Practitioner 1306 N. Berkley Ave, Peoria, IL 61603 2020-10-08
1114588217 Kong Xing Wang Dentist 320 East Armstrong Ave, Peoria, IL 61603 2019-06-28
1073015319 Sara Kristine Rosenbery Nurse Practitioner 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 2018-03-02
1861860058 Jennifer Michelle Kelsey Clinical Nurse Specialist 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 2015-09-04
1467859793 Bonnie Lansing Counselor 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 2014-12-02
1639597172 Jael K. Mahasi Counselor 1800 Ne Perry Avenue, Peoria, IL 61603 2014-04-02
1992054829 Justin S Ferragut Radiology 530 Northeast Glen Oak Avenue, Peoria, IL 61603 2012-09-06
1780952994 Syed Muhammad Tayyab Internal Medicine 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 2011-12-02
1528389079 St. Francis Medical Center General Acute Care Hospital 530 N E Glen Oak Ave, Peoria, IL 61603 2010-06-18
1780810648 Children's Home Association of Illinois Voluntary or Charitable 400 E. Frye, Peoria, IL 61603 2009-06-05
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Taxonomy Information

Taxonomy Code 251S00000X
Grouping Agencies
Classification Community/Behavioral Health

Taxonomy Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition]

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NPI Name Taxonomy Address Enumeration
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1881209583 Alpine Villa Group LLC Community/Behavioral Health 8845 W Potter Dr, Peoria, AZ 85382-6428 2020-09-10
1013556687 Greystone House 2, LLC Community/Behavioral Health 27490 N Higuera Dr, Peoria, AZ 85383-4859 2019-12-31
1659921427 Terpro LLC Community/Behavioral Health 8175 W Ludlow Dr Unit 222, Peoria, AZ 85381-4796 2019-09-13
1528614807 Sage Counseling, Inc. Community/Behavioral Health 8805 W Union Hills Dr Ste 100, Peoria, AZ 85382-8153 2019-08-13
1336607613 Angel Kids Academy LLC Community/Behavioral Health 8910 W Monroe St, Peoria, AZ 85345-6440 2019-03-06
1699269647 Radu Marinescu Community/Behavioral Health 9140 W Hearn Rd, Peoria, AZ 85381-3790 2018-06-21
1740787753 Pathway Youth and Family Services LLC Community/Behavioral Health 9794 W Peoria Ave Ste 13, Peoria, AZ 85345-6138 2018-04-07
1396262044 Az Behavioral Health Services LLC Community/Behavioral Health 9791 W Butler Dr, Peoria, AZ 85345-3725 2017-08-24
1992163380 Treatment Alternatives for Safe Communities Community/Behavioral Health 108 Sw Madison Ave, Peoria, IL 61602-1107 2016-02-01
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Competitor

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City PEORIA
Zip Code 61603

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Dataset Information

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.

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