Provider Demographics
NPI:1720257587
Name:PEORIA CNTY BD FOR CARE CFC 14
Entity type:Organization
Organization Name:PEORIA CNTY BD FOR CARE CFC 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JANSZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-999-7001
Mailing Address - Street 1:2016 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-2415
Mailing Address - Country:US
Mailing Address - Phone:309-999-7001
Mailing Address - Fax:309-681-0190
Practice Address - Street 1:2016 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-2415
Practice Address - Country:US
Practice Address - Phone:309-999-7001
Practice Address - Fax:309-681-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003OtherHSF PROVIDER NUMBER