Provider Demographics
NPI:1154708923
Name:PRAIRIE CENTER HEALTH SYSTEMS
Entity type:Organization
Organization Name:PRAIRIE CENTER HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-693-3021
Mailing Address - Street 1:718 W KILLARNEY ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1015
Mailing Address - Country:US
Mailing Address - Phone:217-328-4500
Mailing Address - Fax:217-239-1129
Practice Address - Street 1:1222 E VOORHEES ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-6249
Practice Address - Country:US
Practice Address - Phone:217-477-4500
Practice Address - Fax:217-443-6613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE CENTER HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA06060007A101YA0400X
ILA-0606-0007-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL006060007Medicaid