CHILDREN'S HOME ASSOCIATION OF ILLINOIS NPI 1003046012

Community Based Residential Treatment Facility, Mental Illness in Peoria, IL

NPI 1003046012 Organization Community Based Residential Treatment Fa...

About CHILDREN'S HOME ASSOCIATION OF ILLINOIS

Children's Home Association Of Illinois is a provider established in Peoria, Illinois specializing in community based residential treatment facility, mental illness. The NPI number of Children's Home Association Of Illinois is 1003046012 and was assigned on July 2009. The practitioner's primary taxonomy code is 320800000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The authorized official of this NPI record is Mr. Patrick Phelan (Vice President Of Operations)

NPI

1003046012

Provider NameCHILDREN'S HOME ASSOCIATION OF ILLINOIS
Provider Location Address901 E NEBRASKA AVE PEORIA, IL 61603
Provider Mailing Address2130 N KNOXVILLE AVE PEORIA, IL 61603
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date07-24-2009
Last Update Date07-24-2009


Primary Taxonomy

Taxonomy Code320800000X
ClassificationCommunity Based Residential Treatment Facility, Mental Illness
TypeResidential Treatment Facilities
Taxonomy DescriptionA home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Business Address

CHILDREN'S HOME ASSOCIATION OF ILLINOIS
901 E NEBRASKA AVE
PEORIA, IL
ZIP 61603
Phone: (309) 687-7432

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Mailing Address

CHILDREN'S HOME ASSOCIATION OF ILLINOIS
2130 N KNOXVILLE AVE
PEORIA, IL
ZIP 61603
Phone:



Authorized Official

Authorized Official NameMR. PATRICK PHELAN
Authorized Official TitleVICE PRESIDENT OF OPERATIONS
Authorized Official Phone(309) 687-7255

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.