NPI 1770960684

Human Service Center

Organisation Substance Abuse Rehabilitation Facility Peoria, IL

Practice location

Address: 130 N Richard Pryor Pl, Peoria, IL 61605-2484
Phone: (309) 671-8005
Mailing address: PO Box 1346, Peoria, IL 61654-1346

Authorised official

Name: Michael Kennedy
Title: President/Ceo
Phone: (309) 671-8005

Registered specialties (2)

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 003240001 (IL)

Other Substance Abuse Rehabilitation Facility providers in Illinois →

Substance Use Disorder Rehabilitation Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QR0405X Licence A-0324-0001-A (IL)

Other Clinic/Center providers in Illinois →

Registry record

NPI: 1770960684
Entity type: Organization
NPI issued: 29 Apr 2015
Record last updated: 12 Dec 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.