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MEDMARK TREATMENT CENTERS CHAMPAIGN
NPI 1033460498
Clinic/Center - Methadone in Champaign, IL

Active since September 26, 2012CLIA 14D2254655 · Waiver
106 S COUNTRY FAIR DR STE C, CHAMPAIGN, IL 61821(217) 373-8200 Get Directions Write a Review

NPPES record last updated: July 29, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 29, 2024, Feb 21, 2023, Feb 12, 2021 (3 updates tracked since 2021).

About Medmark Treatment Centers Champaign NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDMARK TREATMENT CENTERS CHAMPAIGN (NPI 1033460498) is a healthcare organization registered as a methadone in Champaign, Illinois and active in the NPI registry since September 2012. The organization holds a CLIA Waiver certificate valid through March 6, 2028 and lists Bruce Jarvie, Vp, Treasurer, as its authorized official.

NPPES Registry Identity

NPI1033460498
Entity TypeOrganization
Primary Taxonomy261QM2800X
Legal Business NameCHAMPAIGN TREATMENT CENTER, LLC
Location Address106 S COUNTRY FAIR DR STE CChampaign, IL 61821-3064
Mailing Address106 S Country Fair Dr, Suite CChampaign, IL 61821-3063 · (217) 373-8200
Phone(217) 373-8200
Organization SubpartNo
Authorized OfficialBruce JarvieVp, Treasurer · (214) 379-3300
Enumeration DateSeptember 26, 2012
Last NPPES UpdateJuly 29, 20243 updates tracked since enumeration
NPPES CertifiedJuly 29, 2024
✔ NPI 1033460498 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities
Taxonomy Code261QM2800X
Definition

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
106 S COUNTRY FAIR DR STE C, Champaign, IL 61821
Open in Google Maps ↗

Other Names 1

Doing Business AsMedmark Treatment Centers Champaign

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2254655

Medmark Treatment Centers Champaign Champaign Treatment Center, LLC · Champaign, IL
Active · expires Mar 6, 2028
CLIA Number14D2254655
Laboratory TypeNarcotic Trmt Program
Certificate Effective DateMarch 7, 2026
Certificate Expiration DateMarch 6, 2028
Laboratory DirectorRichard L. Maenza
Laboratory Phone(217) 373-8200
Laboratory LocationMedmark Treatment Centers Champaign Champaign Treatment Center, LLC106 S Country Fair Dr - Ste C, Champaign, IL 61821
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMY BULLINGTON MS, CADC
Counselor (Addiction (Substance Use Disorder))
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
LYNDA SUE CURL LPN
Licensed Practical Nurse
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
HILLARY LOPEZ LPN
Licensed Practical Nurse
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
MRS. LATARIKA L DORRIS LPN
Licensed Practical Nurse
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
DANIELLE WARD RN
Registered Nurse (Addiction (Substance Use Disorder))
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (618) 513-7340
SONJA MARIE KOVACEV RN
Registered Nurse (Addiction (Substance Use Disorder))
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
CELINA R WILSON
Licensed Practical Nurse
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200
JENNIFER L CHANDLER
Counselor (Addiction (Substance Use Disorder))
106 S COUNTRY FAIR DR STE C
CHAMPAIGN, IL 61821
Champaign County (217) 373-8200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Champaign Treatment Center, LLC's NPI number?

The NPI number for Champaign Treatment Center, LLC is 1033460498. It was assigned to this organization in the NPPES registry on September 26, 2012. The provider is doing business as Medmark Treatment Centers Champaign.

Where is Champaign Treatment Center, LLC located?

Champaign Treatment Center, LLC is located at 106 S Country Fair Dr Ste C, Champaign, IL 61821. The listed phone number is (217) 373-8200.

What is Champaign Treatment Center, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

Does Champaign Treatment Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2254655) is associated with this NPI, valid through March 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Champaign Treatment Center, LLC was last updated on July 29, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.