Provider Demographics
NPI:1215160049
Name:DEWITT COUNTY HUMAN RESOURCE CENTER
Entity type:Organization
Organization Name:DEWITT COUNTY HUMAN RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL LEITZ
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-935-9496
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-0616
Mailing Address - Country:US
Mailing Address - Phone:217-935-9496
Mailing Address - Fax:217-935-4508
Practice Address - Street 1:1150 ROUTE 54 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2148
Practice Address - Country:US
Practice Address - Phone:217-935-9496
Practice Address - Fax:217-935-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL68349Medicare UPIN
IL532470Medicare PIN